- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.59 / $1,144.93 / $10,743.29
| Facility | | $41.59 | $1,144.93 | $10,743.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.56 / $41.59 / $58.35
| Professional | | $31.56 | $41.59 | $58.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.54 / $88.54 / $88.54
| Professional | | $88.54 | $88.54 | $88.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.13 / $45.60 / $255.86
| Facility | | $23.13 | $45.60 | $255.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.40 / $42.84 / $44.98
| Professional | | $36.40 | $42.84 | $44.98 |