- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.14 / $1,819.70 / $6,165.95
| Facility | | $15.14 | $1,819.70 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $2,187.76
| Professional | | $1,000.00 | $1,000.00 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $56.23 / $69.18
| Facility | | $50.12 | $56.23 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $15.14 / $25.70
| Professional | | $6.76 | $15.14 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,890.45 / $9,549.93
| Facility | | $2,290.87 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,380.38 / $1,513.56
| Professional | | $1,174.90 | $1,380.38 | $1,513.56 |