- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.48 / $613.53 / $3,706.14
| Facility | | $206.48 | $613.53 | $3,706.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.14 / $69.62 / $91.45
| Professional | | $22.14 | $69.62 | $91.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.85 / $66.70 / $138.78
| Professional | | $33.85 | $66.70 | $138.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.71 / $106.71 / $106.71
| Facility | | $106.71 | $106.71 | $106.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.56 / $74.90 / $198.00
| Professional | | $37.56 | $74.90 | $198.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.90 / $87.47 / $144.27
| Professional | | $51.90 | $87.47 | $144.27 |