- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.57 / $64.84 / $1,146.40
| Facility | | $21.57 | $64.84 | $1,146.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.36 / $43.20 / $578.78
| Professional | | $13.36 | $43.20 | $578.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.04 / $135.68 / $623.66
| Professional | | $13.04 | $135.68 | $623.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.28 / $64.19 / $67.70
| Facility | | $61.28 | $64.19 | $67.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.76 / $107.81 / $1,019.47
| Professional | | $13.76 | $107.81 | $1,019.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.59 / $293.79 / $446.79
| Professional | | $74.59 | $293.79 | $446.79 |