- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.77 / $54.05 / $81.51
| Facility | | $14.77 | $54.05 | $81.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.00 / $160.87 / $5,000.00
| Professional | | $27.00 | $160.87 | $5,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.02 / $4.26 / $92.00
| Facility | | $3.02 | $4.26 | $92.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,995.49 / $2,995.49 / $3,744.36
| Professional | | $2,995.49 | $2,995.49 | $3,744.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.00 / $14.00 / $14.00
| Professional | | $14.00 | $14.00 | $14.00 |