- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.60 / $57.41 / $313.41
| Facility | | $48.60 | $57.41 | $313.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.32 / $117.08 / $358.18
| Professional | | $18.32 | $117.08 | $358.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.69 / $50.69 / $91.00
| Professional | | $50.69 | $50.69 | $91.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.62 / $27.64 / $71.04
| Facility | | $20.62 | $27.64 | $71.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.50 / $12.50 / $12,381.00
| Facility | | $12.50 | $12.50 | $12,381.00 |