- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $363.08 / $537.03
| Facility | | $30.20 | $363.08 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $562.34
| Professional | | $30.20 | $47.86 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $457.09
| Professional | | $407.38 | $407.38 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.27 / $4.90 / $5.37
| Professional | | $4.27 | $4.90 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $338.84 / $457.09
| Professional | | $223.87 | $338.84 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $426.58 / $512.86
| Professional | | $309.03 | $426.58 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $2,454.71 / $4,786.30
| Facility | | $43.65 | $2,454.71 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.44 / $64.57 / $100.00
| Facility | | $23.44 | $64.57 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $64.57 / $100.00
| Professional | | $23.44 | $64.57 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $60.26 / $83.18
| Professional | | $44.67 | $60.26 | $83.18 |