- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.75 / $57.00 / $580.23
| Facility | | $21.75 | $57.00 | $580.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.00 / $179.29 / $5,000.01
| Professional | | $27.00 | $179.29 | $5,000.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.05 / $1.05 / $1,570.00
| Professional | | $1.05 | $1.05 | $1,570.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.40 / $53.55 / $75.66
| Facility | | $5.40 | $53.55 | $75.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,995.49 / $3,025.44 / $3,744.36
| Professional | | $2,995.49 | $3,025.44 | $3,744.36 |