- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.08 / $302.08 / $6,907.00
| Facility | | $302.08 | $302.08 | $6,907.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.45 / $75.70 / $175.93
| Professional | | $34.45 | $75.70 | $175.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.00 / $53.00 / $53.00
| Facility | | $53.00 | $53.00 | $53.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.51 / $96.65 / $149.63
| Professional | | $39.51 | $96.65 | $149.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.70 / $40.70 / $107.86
| Professional | | $40.70 | $40.70 | $107.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.00 / $143.00 / $143.00
| Facility | | $104.00 | $143.00 | $143.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.75 / $100.48 / $233.69
| Professional | | $73.75 | $100.48 | $233.69 |