- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.13 / $38.54 / $209.06
| Facility | | $37.13 | $38.54 | $209.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.90 / $37.60 / $47.00
| Professional | | $32.90 | $37.60 | $47.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.80 / $54.80 / $54.80
| Facility | | $54.80 | $54.80 | $54.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.58 / $54.80 / $54.80
| Professional | | $46.58 | $54.80 | $54.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.40 / $616.88 / $1,480.69
| Facility | | $56.40 | $616.88 | $1,480.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.05 / $65.80 / $869.90
| Professional | | $54.05 | $65.80 | $869.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.55 / $36.57 / $62.02
| Facility | | $30.55 | $36.57 | $62.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.25 / $60.05 / $226.54
| Professional | | $35.25 | $60.05 | $226.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.73 / $28.20 / $51.70
| Professional | | $19.73 | $28.20 | $51.70 |