- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $549.54 / $794.33
| Facility | | $30.20 | $549.54 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $831.76
| Professional | | $30.20 | $47.86 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $616.60 / $691.83
| Professional | | $616.60 | $616.60 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $4.17 / $5.37
| Professional | | $3.31 | $4.17 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $549.54 / $724.44
| Professional | | $363.08 | $549.54 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $645.65 / $758.58
| Professional | | $457.09 | $645.65 | $758.58 |
- 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 |