- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.25 / $227.70 / $850.00
| Facility | | $14.25 | $227.70 | $850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.05 / $14.05 / $14.26
| Professional | | $14.05 | $14.05 | $14.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.32 / $24.37 / $38.54
| Professional | | $17.32 | $24.37 | $38.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.57 / $18.51 / $27.74
| Professional | | $10.57 | $18.51 | $27.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.07 / $17.38 / $34.15
| Professional | | $14.07 | $17.38 | $34.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.48 / $16.59 / $33.97
| Professional | | $13.48 | $16.59 | $33.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,500.00 / $3,000.00 / $4,410.00
| Professional | | $2,500.00 | $3,000.00 | $4,410.00 |