- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.94 / $3,162.28 / $4,570.88
| Facility | | $7.94 | $3,162.28 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $52.48 / $87.10
| Professional | | $7.94 | $52.48 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $44.67 / $44.67
| Professional | | $30.20 | $44.67 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $218.78 / $489.78
| Facility | | $186.21 | $218.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $27.54 / $102.33
| Professional | | $23.44 | $27.54 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $75.86 / $79.43
| Professional | | $46.77 | $75.86 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $91.20 / $104.71
| Professional | | $85.11 | $91.20 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,466.84 / $5,128.61
| Facility | | $1,071.52 | $4,466.84 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $26.30 / $102.33
| Professional | | $19.05 | $26.30 | $102.33 |