- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.92 / $9,780.16 / $16,684.43
| Facility | | $202.92 | $9,780.16 | $16,684.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.31 / $46.50 / $57.09
| Professional | | $45.31 | $46.50 | $57.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.52 / $105.61 / $184.46
| Facility | | $53.52 | $105.61 | $184.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.58 / $86.45 / $114.41
| Professional | | $45.58 | $86.45 | $114.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.75 / $45.31 / $45.31
| Facility | | $42.75 | $45.31 | $45.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.31 / $45.31 / $45.31
| Professional | | $45.31 | $45.31 | $45.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.12 / $52.34 / $126.21
| Facility | | $47.12 | $52.34 | $126.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.67 / $81.67 / $81.67
| Professional | | $81.67 | $81.67 | $81.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.31 / $45.31 / $50.75
| Professional | | $45.31 | $45.31 | $50.75 |