- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.58 / $117.99 / $220.96
| Professional | | $53.58 | $117.99 | $220.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.48 / $90.85 / $152.74
| Professional | | $66.48 | $90.85 | $152.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.04 / $123.89 / $220.96
| Facility | | $67.04 | $123.89 | $220.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.06 / $97.04 / $170.78
| Professional | | $80.06 | $97.04 | $170.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $78.00 / $152.76
| Professional | | $30.00 | $78.00 | $152.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.95 / $456.28 / $600.16
| Facility | | $353.95 | $456.28 | $600.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.15 / $99.67 / $179.96
| Professional | | $92.15 | $99.67 | $179.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,800.00 / $8,244.00 / $9,193.00
| Facility | | $1,800.00 | $8,244.00 | $9,193.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.50 / $114.99 / $182.49
| Professional | | $89.50 | $114.99 | $182.49 |