- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.77 / $4,897.79 / $16,595.87
| Facility | | $46.77 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $39.81 / $57.54
| Professional | | $30.90 | $39.81 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $15.14 / $15.14
| Professional | | $15.14 | $15.14 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $37.15 / $45.71
| Professional | | $26.30 | $37.15 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $46.77 / $83.18
| Professional | | $32.36 | $46.77 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.62 / $42.66 / $57.54
| Facility | | $31.62 | $42.66 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $10,964.78 / $16,982.44
| Facility | | $1,995.26 | $10,964.78 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $38.02 / $63.10
| Professional | | $30.20 | $38.02 | $63.10 |