- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $63.10 / $1,000.00
| Facility | | $36.31 | $63.10 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $34.67 / $52.48
| Professional | | $22.91 | $34.67 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $26.30 / $31.62
| Professional | | $21.38 | $26.30 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $40.74 / $40.74
| Professional | | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $36.31 / $81.28
| Professional | | $28.18 | $36.31 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.91 / $42.66 / $72.44
| Facility | | $22.91 | $42.66 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $37.15 / $158.49
| Professional | | $26.92 | $37.15 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $34.67 / $44.67
| Professional | | $26.92 | $34.67 | $44.67 |