- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.24 / $3,565.20 / $6,420.10
| Facility | | $29.24 | $3,565.20 | $6,420.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $29.67 / $29.67
| Professional | | $29.38 | $29.67 | $29.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.88 / $37.51 / $37.51
| Professional | | $31.88 | $37.51 | $37.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.72 / $27.72 / $27.72
| Facility | | $27.72 | $27.72 | $27.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $29.38 / $41.58
| Professional | | $29.38 | $29.38 | $41.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.38 / $29.38 / $32.71
| Professional | | $29.38 | $29.38 | $32.71 |