- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.79 / $475.21 / $3,706.14
| Facility | | $130.79 | $475.21 | $3,706.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.21 / $56.80 / $84.79
| Professional | | $47.21 | $56.80 | $84.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.93 / $68.31 / $94.66
| Professional | | $46.93 | $68.31 | $94.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.06 / $78.48 / $133.44
| Professional | | $58.06 | $78.48 | $133.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.08 / $89.77 / $143.28
| Professional | | $50.08 | $89.77 | $143.28 |