- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $3,162.28 / $4,570.88
| Facility | | $245.47 | $3,162.28 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $91.20 / $245.47
| Professional | | $72.44 | $91.20 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $120.23
| Professional | | $109.65 | $109.65 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $44.67 / $104.71
| Professional | | $30.20 | $44.67 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $112.20 / $131.83
| Professional | | $95.50 | $112.20 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $95.50 / $120.23
| Professional | | $57.54 | $95.50 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $114.82 / $134.90
| Professional | | $109.65 | $114.82 | $134.90 |
- 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
- $77.62 / $93.33 / $147.91
| Professional | | $77.62 | $93.33 | $147.91 |