- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $2,398.83 / $10,471.29
| Facility | | $239.88 | $2,398.83 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $239.88 / $707.95
| Professional | | $239.88 | $239.88 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $0.02 / $2.40
| Professional | | $0.02 | $0.02 | $2.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $309.03 / $537.03
| Facility | | $239.88 | $309.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $933.25 / $4,073.80
| Facility | | $100.00 | $933.25 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $933.25 / $4,073.80
| Professional | | $100.00 | $933.25 | $4,073.80 |