- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.47 / $4,036.03 / $7,334.64
| Facility | | $160.47 | $4,036.03 | $7,334.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.74 / $38.59 / $2,673.50
| Professional | | $9.74 | $38.59 | $2,673.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.61 / $12.61 / $22.75
| Professional | | $12.61 | $12.61 | $22.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.00 / $612.00 / $612.00
| Professional | | $612.00 | $612.00 | $612.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.40 / $125.40 / $125.40
| Professional | | $125.40 | $125.40 | $125.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.65 / $34.65 / $249.50
| Facility | | $34.65 | $34.65 | $249.50 |