- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $588.84 / $2,454.71
| Facility | | $63.10 | $588.84 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $79.43 / $2,818.38
| Professional | | $75.86 | $79.43 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.18 / $57.54 / $114.82
| Facility | | $28.18 | $57.54 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $30.90 / $53.70
| Professional | | $0.02 | $30.90 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $213.80 / $489.78
| Facility | | $104.71 | $213.80 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $128.82 / $208.93
| Professional | | $102.33 | $128.82 | $208.93 |