- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.44 / $1,518.41 / $16,461.43
| Facility | | $321.44 | $1,518.41 | $16,461.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.47 / $107.62 / $146.21
| Professional | | $60.47 | $107.62 | $146.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.08 / $89.28 / $142.56
| Professional | | $55.08 | $89.28 | $142.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.12 / $123.95 / $209.94
| Professional | | $76.12 | $123.95 | $209.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.81 / $147.16 / $220.39
| Professional | | $90.81 | $147.16 | $220.39 |