- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $346.74 / $616.60
| Facility | | $239.88 | $346.74 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $52.48 / $724.44
| Professional | | $30.20 | $52.48 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.33 / $9.33 / $9.33
| Professional | | $9.33 | $9.33 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $302.00 / $457.09
| Professional | | $181.97 | $302.00 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.69 / $2,238.72 / $3,981.07
| Facility | | $41.69 | $2,238.72 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $20.89 / $85.11
| Professional | | $3.98 | $20.89 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $61.66 / $100.00
| Professional | | $39.81 | $61.66 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $2,398.83
| Professional | | $1,122.02 | $1,122.02 | $2,398.83 |