- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.70 / $51.58 / $102.80
| Facility | | $30.70 | $51.58 | $102.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.42 / $30.81 / $32.43
| Professional | | $18.42 | $30.81 | $32.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.37 / $36.07 / $67.66
| Professional | | $25.37 | $36.07 | $67.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $2,685.00
| Professional | | $50.00 | $50.00 | $2,685.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.58 / $1,151.23 / $1,151.23
| Facility | | $1,108.58 | $1,151.23 | $1,151.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.36 / $34.79 / $74.12
| Professional | | $24.36 | $34.79 | $74.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.22 / $38.22 / $38.22
| Professional | | $38.22 | $38.22 | $38.22 |