- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.56 / $1,048.32 / $5,739.25
| Facility | | $35.56 | $1,048.32 | $5,739.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.56 / $39.11 / $73.23
| Professional | | $35.56 | $39.11 | $73.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.54 / $88.54 / $88.54
| Professional | | $88.54 | $88.54 | $88.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.05 / $30.00 / $60.00
| Professional | | $13.05 | $30.00 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.59 / $43.11 / $61.89
| Facility | | $32.59 | $43.11 | $61.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.70 / $50.15 / $52.79
| Professional | | $40.70 | $50.15 | $52.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.84 / $42.84 / $42.84
| Professional | | $42.84 | $42.84 | $42.84 |