- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.05 / $3,630.78 / $10,000.00
| Facility | | $19.05 | $3,630.78 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $16.22 / $20.42
| Professional | | $13.49 | $16.22 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $29.51 / $37.15
| Professional | | $23.44 | $29.51 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.49 / $23.99 / $36.31
| Facility | | $15.49 | $23.99 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.14 / $21.88 / $7,413.10
| Facility | | $15.14 | $21.88 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,202.26 / $2,454.71
| Facility | | $229.09 | $1,202.26 | $2,454.71 |