- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.66 / $4,722.42 / $10,492.00
| Facility | | $64.66 | $4,722.42 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.75 / $52.21 / $61.83
| Professional | | $37.75 | $52.21 | $61.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.14 / $156.55 / $271.17
| Facility | | $114.14 | $156.55 | $271.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.88 / $53.82 / $70.77
| Professional | | $38.88 | $53.82 | $70.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.06 / $137.33 / $249.41
| Facility | | $40.06 | $137.33 | $249.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.36 / $80.36 / $80.36
| Professional | | $80.36 | $80.36 | $80.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.06 / $73.08 / $179.08
| Professional | | $47.06 | $73.08 | $179.08 |