- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.80 / $3,000.00 / $8,652.00
| Facility | | $24.80 | $3,000.00 | $8,652.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.94 / $22.49 / $32.81
| Professional | | $14.94 | $22.49 | $32.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.76 / $29.06 / $45.20
| Professional | | $19.76 | $29.06 | $45.20 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $20.62 / $33.04 / $48.67
| Professional | 50 | $20.62 | $33.04 | $48.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.62 / $27.25 / $38.90
| Professional | | $19.62 | $27.25 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.75 / $24.39 / $35.47
| Facility | | $16.75 | $24.39 | $35.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.51 / $27.49 / $47.70
| Professional | | $19.51 | $27.49 | $47.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.00 / $1,464.00 / $3,011.00
| Facility | | $730.00 | $1,464.00 | $3,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.20 / $37.50 / $62.27
| Professional | | $27.20 | $37.50 | $62.27 |