- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.50 / $143.50 / $217.46
| Facility | | $143.50 | $143.50 | $217.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.73 / $217.46 / $217.46
| Professional | | $100.73 | $217.46 | $217.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.00 / $72.00 / $809.79
| Facility | | $36.00 | $72.00 | $809.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.30 / $36.00 / $225.00
| Professional | | $6.30 | $36.00 | $225.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,442.98 / $16,442.98 / $23,242.91
| Facility | | $16,442.98 | $16,442.98 | $23,242.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,749.62 / $36,749.62 / $36,749.62
| Professional | | $36,749.62 | $36,749.62 | $36,749.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $143.50 / $143.50 / $264.45
| Facility | | $143.50 | $143.50 | $264.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.52 / $47.52 / $47.52
| Professional | | $47.52 | $47.52 | $47.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.46 / $21.46 / $116.26
| Professional | | $21.46 | $21.46 | $116.26 |