- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.92 / $2,398.83 / $8,317.64
| Facility | | $26.92 | $2,398.83 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $22.91 / $63.10
| Professional | | $14.45 | $22.91 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,715.35 / $10,000.00
| Facility | | $1,548.82 | $3,715.35 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $26.30 / $48.98
| Professional | | $16.22 | $26.30 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $24.55 / $38.90 / $70.79
| Professional | 50 | $24.55 | $38.90 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.84 / $79.43 / $213.80
| Facility | | $28.84 | $79.43 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $28.84 / $60.26
| Professional | | $16.98 | $28.84 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,630.78
| Facility | | $295.12 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $25.70 / $47.86
| Professional | | $15.85 | $25.70 | $47.86 |