- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.22 / $501.19 / $8,216.14
| Facility | | $318.22 | $501.19 | $8,216.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.62 / $318.22 / $1,270.80
| Professional | | $256.62 | $318.22 | $1,270.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.48 / $60.64 / $60.64
| Professional | | $45.48 | $60.64 | $60.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.84 / $673.84 / $673.84
| Professional | | $673.84 | $673.84 | $673.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $3,000.00
| Professional | | $45.00 | $45.00 | $3,000.00 |