- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.42 / $34.08 / $2,000.00
| Facility | | $25.42 | $34.08 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.42 / $83.46 / $190.93
| Professional | | $25.42 | $83.46 | $190.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.00 / $64.34 / $82.89
| Professional | | $48.00 | $64.34 | $82.89 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $72.00 / $93.18 / $124.34
| Professional | 50 | $72.00 | $93.18 | $124.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.75 / $69.38 / $108.42
| Professional | | $45.75 | $69.38 | $108.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.42 / $41.15 / $221.51
| Facility | | $25.42 | $41.15 | $221.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.51 / $165.28 / $300.50
| Professional | | $38.51 | $165.28 | $300.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.01 / $88.71 / $282.13
| Professional | | $35.01 | $88.71 | $282.13 |