- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.44 / $186.21 / $5,011.87
| Facility | | $72.44 | $186.21 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $141.25 / $275.42
| Professional | | $67.61 | $141.25 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $120.23 / $154.88
| Professional | | $61.66 | $120.23 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,466.84 / $7,413.10
| Facility | | $3,630.78 | $4,466.84 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Professional | | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $5,011.87
| Facility | | $5,011.87 | $5,011.87 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $104.71 / $186.21
| Professional | | $64.57 | $104.71 | $186.21 |