- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $6,606.93 / $6,606.93
| Facility | | $120.23 | $6,606.93 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $162.18 / $457.09 / $912.01
| Professional | 50 | $162.18 | $457.09 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $295.12 / $537.03
| Facility | | $154.88 | $295.12 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | 50 | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $281.84 / $575.44
| Professional | | $263.03 | $281.84 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $331.13 / $467.74
| Professional | | $199.53 | $331.13 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |