- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.03 / $7,913.40 / $14,999.08
| Facility | | $108.03 | $7,913.40 | $14,999.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.65 / $34.65 / $15,685.60
| Professional | | $34.65 | $34.65 | $15,685.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.61 / $12.61 / $14.12
| Professional | | $12.61 | $12.61 | $14.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.99 / $125.40 / $125.40
| Professional | | $4.99 | $125.40 | $125.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.59 / $100.00 / $2,673.50
| Facility | | $38.59 | $100.00 | $2,673.50 |