- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $1,288.25 / $2,454.71
| Facility | | $51.29 | $1,288.25 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $40.74 / $56.23
| Professional | | $34.67 | $40.74 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $66.07 / $380.19
| Professional | | $42.66 | $66.07 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $331.13 / $851.14
| Facility | | $128.82 | $331.13 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $51.29 / $426.58
| Professional | | $34.67 | $51.29 | $426.58 |