- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.48 / $3,603.96 / $23,806.23
| Facility | | $81.48 | $3,603.96 | $23,806.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.55 / $52.30 / $273.16
| Professional | | $47.55 | $52.30 | $273.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.54 / $23.73 / $116.63
| Facility | | $22.54 | $23.73 | $116.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.63 / $53.63 / $53.63
| Professional | | $53.63 | $53.63 | $53.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.89 / $47.55 / $120.00
| Facility | | $41.89 | $47.55 | $120.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.55 / $47.55 / $47.55
| Professional | | $47.55 | $47.55 | $47.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.28 / $60.59 / $108.81
| Facility | | $43.28 | $60.59 | $108.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.28 / $48.18 / $160.44
| Professional | | $43.28 | $48.18 | $160.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.55 / $50.40 / $86.33
| Professional | | $47.55 | $50.40 | $86.33 |