- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.48 / $2,957.16 / $9,246.01
| Facility | | $103.48 | $2,957.16 | $9,246.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.59 / $66.09 / $108.88
| Professional | | $45.59 | $66.09 | $108.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.02 / $79.91 / $128.55
| Professional | | $51.02 | $79.91 | $128.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.16 / $3,870.59 / $9,647.99
| Facility | | $147.16 | $3,870.59 | $9,647.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $500.00 / $500.00
| Facility | | $500.00 | $500.00 | $500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.31 / $104.79 / $206.05
| Professional | | $71.31 | $104.79 | $206.05 |