- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.73 / $50.71 / $1,032.18
| Facility | | $30.73 | $50.71 | $1,032.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $36.68 / $50.71
| Professional | | $24.55 | $36.68 | $50.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.85 / $301.99 / $406.27
| Facility | | $248.85 | $301.99 | $406.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.55 / $35.00 / $48.48
| Professional | | $25.55 | $35.00 | $48.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.07 / $20.16 / $72.28
| Professional | | $12.07 | $20.16 | $72.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.61 / $37.04 / $41.86
| Professional | | $30.61 | $37.04 | $41.86 |