- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.60 / $33.01 / $2,000.00
| Facility | | $14.60 | $33.01 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.25 / $25.33 / $33.35
| Professional | | $13.25 | $25.33 | $33.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.28 / $63.69 / $80.33
| Professional | | $28.28 | $63.69 | $80.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.85 / $45.36 / $104.43
| Professional | | $25.85 | $45.36 | $104.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.60 / $33.01 / $56.12
| Facility | | $14.60 | $33.01 | $56.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.56 / $60.56 / $246.24
| Professional | | $33.56 | $60.56 | $246.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $48.44 / $71.25
| Professional | | $33.11 | $48.44 | $71.25 |