- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.71 / $218.78 / $467.74
| Facility | | $45.71 | $218.78 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $15.14 / $52.48
| Professional | | $3.02 | $15.14 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $19.95 / $1,096.48
| Professional | | $15.14 | $19.95 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $17.78 / $17.78
| Facility | | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $17.78 / $17.78
| Professional | | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38,018.94 / $38,018.94 / $38,018.94
| Professional | | $38,018.94 | $38,018.94 | $38,018.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $20.89 / $21.38
| Professional | | $19.50 | $20.89 | $21.38 |