- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $3,162.28 / $4,570.88
| Facility | | $181.97 | $3,162.28 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $151.36 / $354.81
| Professional | | $58.88 | $151.36 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $151.36 / $281.84
| Professional | | $74.13 | $151.36 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $134.90
| Professional | | $32.36 | $33.11 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $177.83 / $275.42
| Professional | | $81.28 | $177.83 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $154.88 / $302.00
| Professional | | $100.00 | $154.88 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $194.98 / $309.03
| Professional | | $75.86 | $194.98 | $309.03 |
- 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
- $60.26 / $131.83 / $223.87
| Professional | | $60.26 | $131.83 | $223.87 |