- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.70 / $34.67 / $58.88
| Facility | | $25.70 | $34.67 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $30.90 / $85.11
| Professional | | $16.98 | $30.90 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $3,162.28 / $10,471.29
| Facility | | $2,137.96 | $3,162.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $72.44 / $109.65
| Professional | | $22.91 | $72.44 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $34.67 / $114.82 / $165.96
| Professional | 50 | $34.67 | $114.82 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $50.12 / $50.12
| Facility | | $50.12 | $50.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $60.26 / $104.71
| Professional | | $30.20 | $60.26 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $56.23 / $100.00
| Professional | | $29.51 | $56.23 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,467.37 / $6,760.83
| Facility | | $1,288.25 | $3,467.37 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $44.67 / $91.20
| Professional | | $19.50 | $44.67 | $91.20 |