- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.86 / $57.00 / $667.00
| Facility | | $50.86 | $57.00 | $667.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.18 / $42.21 / $52.89
| Professional | | $40.18 | $42.21 | $52.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.06 / $33.06 / $33.06
| Facility | | $33.06 | $33.06 | $33.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.40 / $58.23 / $95.22
| Professional | | $36.40 | $58.23 | $95.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.97 / $135.29 / $237.90
| Facility | | $35.97 | $135.29 | $237.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.36 / $30.52 / $71.05
| Professional | | $21.36 | $30.52 | $71.05 |