- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $676.08 / $977.24
| Facility | | $30.20 | $676.08 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $47.86 / $1,096.48
| Professional | | $30.20 | $47.86 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $2,187.76
| Professional | | $1,445.44 | $1,445.44 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.47 / $5.37
| Professional | | $3.02 | $3.47 | $5.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $691.83 / $912.01
| Professional | | $446.68 | $691.83 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $776.25 / $933.25
| Professional | | $562.34 | $776.25 | $933.25 |
- 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 |