- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.48 / $3,400.58 / $9,786.40
| Facility | | $53.48 | $3,400.58 | $9,786.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.22 / $53.48 / $79.00
| Professional | | $51.22 | $53.48 | $79.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.67 / $81.00 / $124.10
| Professional | | $52.67 | $81.00 | $124.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.08 / $87.89 / $95.82
| Facility | | $66.08 | $87.89 | $95.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.89 / $82.67 / $147.27
| Professional | | $81.89 | $82.67 | $147.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.04 / $72.04 / $82.85
| Professional | | $72.04 | $72.04 | $82.85 |