- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $51.29 / $128.82
| Facility | | $34.67 | $51.29 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $75.86 / $177.83
| Professional | | $40.74 | $75.86 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $26.92 / $40.74
| Professional | | $18.20 | $26.92 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,290.87 / $2,951.21
| Facility | | $1,659.59 | $2,290.87 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $28.18 / $1,862.09
| Professional | | $19.95 | $28.18 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $19.50 / $23.44
| Professional | | $11.22 | $19.50 | $23.44 |