- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.90 / $3,162.28 / $4,570.88
| Facility | | $30.90 | $3,162.28 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $28.84 / $56.23
| Professional | | $12.30 | $28.84 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $26.30 / $51.29
| Professional | | $17.78 | $26.30 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $33.11 / $91.20
| Professional | | $25.12 | $33.11 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $107.15 / $245.47
| Facility | | $91.20 | $107.15 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $27.54 / $54.95
| Professional | | $15.85 | $27.54 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $32.36 / $60.26
| Professional | | $16.60 | $32.36 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $41.69 / $60.26
| Professional | | $17.38 | $41.69 | $60.26 |
- 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
- $12.88 / $25.12 / $43.65
| Professional | | $12.88 | $25.12 | $43.65 |