- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,145.78 / $7,838.38
| Facility | | $1,000.00 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.00 / $57.83 / $61.98
| Professional | | $8.00 | $57.83 | $61.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $198.60
| Professional | | $60.00 | $85.00 | $198.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.08 / $45.08 / $53.77
| Facility | | $45.08 | $45.08 | $53.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $775.00 / $1,327.00 / $1,327.00
| Facility | | $775.00 | $1,327.00 | $1,327.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.23 / $31.00 / $44.55
| Professional | | $24.23 | $31.00 | $44.55 |