- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.35 / $215.82 / $516.76
| Facility | | $196.35 | $215.82 | $516.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $10.50 / $41.30
| Professional | | $7.00 | $10.50 | $41.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.03 / $295.13 / $818.35
| Facility | | $0.03 | $295.13 | $818.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $3,335.23
| Professional | | $0.02 | $0.02 | $3,335.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.00 / $246.11 / $313.89
| Facility | | $206.00 | $246.11 | $313.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.32 / $230.88 / $331.08
| Facility | | $110.32 | $230.88 | $331.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.40 / $54.40 / $167.00
| Professional | | $54.40 | $54.40 | $167.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,335.23 / $3,335.23 / $3,335.23
| Professional | | $3,335.23 | $3,335.23 | $3,335.23 |