- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.98 / $4,466.84 / $10,232.93
| Facility | | $48.98 | $4,466.84 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $57.54 / $89.13
| Professional | | $43.65 | $57.54 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $66.07 / $97.72
| Professional | | $57.54 | $66.07 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $11.75 / $13.80
| Professional | | $10.96 | $11.75 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,288.25 / $2,041.74
| Facility | | $199.53 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $14.13 / $22.91
| Professional | | $11.75 | $14.13 | $22.91 |