- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $5,888.44 / $10,964.78
| Facility | | $3,311.31 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $32.36 / $190.55
| Professional | | $19.95 | $32.36 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $154.88 / $346.74
| Professional | | $51.29 | $154.88 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $67.61 / $107.15
| Professional | | $58.88 | $67.61 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $776.25 / $1,230.27
| Facility | | $512.86 | $776.25 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $26.92 / $63.10
| Professional | | $18.20 | $26.92 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $2,884.03 / $7,762.47
| Facility | | $1,318.26 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $33.11 / $56.23
| Professional | | $18.62 | $33.11 | $56.23 |