- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $137.66 / $1,037.24
| Facility | | $40.00 | $137.66 | $1,037.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.17 / $32.58 / $48.13
| Professional | | $30.17 | $32.58 | $48.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.09 / $42.20 / $83.38
| Facility | | $40.09 | $42.20 | $83.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.61 / $32.61 / $32.61
| Professional | | $32.61 | $32.61 | $32.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.46 / $28.46 / $30.17
| Facility | | $28.46 | $28.46 | $30.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.17 / $30.17 / $30.17
| Professional | | $30.17 | $30.17 | $30.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.91 / $41.64 / $48.48
| Facility | | $27.91 | $41.64 | $48.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.36 / $27.36 / $43.78
| Professional | | $27.36 | $27.36 | $43.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.17 / $30.17 / $48.27
| Professional | | $30.17 | $30.17 | $48.27 |