- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $4,677.35 / $10,471.29
| Facility | | $64.57 | $4,677.35 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $15.14 / $43.65
| Professional | | $6.03 | $15.14 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $19.05 / $32.36
| Professional | | $7.94 | $19.05 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $69.18
| Facility | | $50.12 | $50.12 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $21.38
| Professional | | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $6,760.83
| Facility | | $1,288.25 | $3,890.45 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $15.85 / $39.81
| Professional | | $7.41 | $15.85 | $39.81 |