- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.66 / $90.78 / $12,402.43
| Facility | | $56.66 | $90.78 | $12,402.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.84 / $67.06 / $72.37
| Professional | | $42.84 | $67.06 | $72.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.86 / $219.86 / $219.86
| Facility | | $219.86 | $219.86 | $219.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.66 / $59.49 / $328.49
| Facility | | $56.66 | $59.49 | $328.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.50 / $78.45 / $440.48
| Professional | | $63.50 | $78.45 | $440.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.07 / $74.70 / $114.78
| Professional | | $61.07 | $74.70 | $114.78 |