- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $65.40 / $5,250.34 / $9,524.99
| Facility | | $65.40 | $5,250.34 | $9,524.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.96 / $54.39 / $4,219.00
| Professional | | $48.96 | $54.39 | $4,219.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.12 / $167.43 / $275.10
| Facility | | $42.12 | $167.43 | $275.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.97 / $46.50 / $311.43
| Professional | | $31.97 | $46.50 | $311.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.19 / $48.96 / $48.96
| Facility | | $46.19 | $48.96 | $48.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.96 / $48.96 / $48.96
| Professional | | $48.96 | $48.96 | $48.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.99 / $74.97 / $75.55
| Facility | | $49.99 | $74.97 | $75.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.03 / $48.03 / $52.99
| Professional | | $48.03 | $48.03 | $52.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.96 / $48.96 / $48.96
| Professional | | $48.96 | $48.96 | $48.96 |