- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.57 / $1,096.48 / $3,890.45
| Facility | | $64.57 | $1,096.48 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $56.23 / $100.00
| Professional | | $28.18 | $56.23 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $47.86 / $64.57
| Professional | | $39.81 | $47.86 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $239.88 / $416.87
| Facility | | $144.54 | $239.88 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $47.86 / $64.57
| Professional | | $30.90 | $47.86 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $42.66 / $42.66
| Facility | | $39.81 | $42.66 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $48.98 / $81.28
| Professional | | $28.18 | $48.98 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $478.63 / $1,202.26
| Facility | | $190.55 | $478.63 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $46.77 / $74.13
| Professional | | $28.18 | $46.77 | $74.13 |