- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $1,698.24 / $5,011.87
| Facility | | $131.83 | $1,698.24 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $114.82 / $194.98
| Professional | | $46.77 | $114.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $109.65 / $218.78
| Professional | | $56.23 | $109.65 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $114.82 / $281.84
| Professional | | $52.48 | $114.82 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $95.50 / $190.55
| Professional | | $34.67 | $95.50 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.24 / $69.18 / $190.55
| Professional | | $0.24 | $69.18 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $128.82 / $128.82
| Professional | | $46.77 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $1,288.25 / $2,041.74
| Facility | | $199.53 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $109.65 / $257.04
| Professional | | $50.12 | $109.65 | $257.04 |