- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.64 / $570.28 / $3,706.14
| Facility | | $268.64 | $570.28 | $3,706.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.87 / $100.91 / $154.82
| Professional | | $49.87 | $100.91 | $154.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.59 / $80.02 / $129.94
| Professional | | $45.59 | $80.02 | $129.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.78 / $125.24 / $213.75
| Professional | | $58.78 | $125.24 | $213.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $320.00 / $1,401.00 / $6,383.00
| Facility | | $320.00 | $1,401.00 | $6,383.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.76 / $118.87 / $175.54
| Professional | | $75.76 | $118.87 | $175.54 |