- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.46 / $62.54 / $93.81
| Facility | | $33.46 | $62.54 | $93.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.57 / $41.35 / $11,159.30
| Professional | | $31.57 | $41.35 | $11,159.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.61 / $107.46 / $174.08
| Facility | | $26.61 | $107.46 | $174.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.85 / $30.33 / $198.89
| Professional | | $20.85 | $30.33 | $198.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.50 / $31.27 / $31.27
| Facility | | $29.50 | $31.27 | $31.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.27 / $31.27 / $31.27
| Professional | | $31.27 | $31.27 | $31.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.30 / $41.35 / $75.00
| Facility | | $31.30 | $41.35 | $75.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.33 / $31.33 / $31.33
| Professional | | $31.33 | $31.33 | $31.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.27 / $31.27 / $31.27
| Professional | | $31.27 | $31.27 | $31.27 |