- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.18 / $153.18 / $540.00
| Facility | | $153.18 | $153.18 | $540.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.79 / $36.59 / $173.72
| Professional | | $31.79 | $36.59 | $173.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.64 / $70.64 / $70.64
| Professional | | $70.64 | $70.64 | $70.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.54 / $66.98 / $121.12
| Facility | | $18.54 | $66.98 | $121.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.36 / $61.82 / $84.22
| Professional | | $46.36 | $61.82 | $84.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.82 / $46.82 / $50.43
| Facility | | $46.82 | $46.82 | $50.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.18 / $34.18 / $84.00
| Professional | | $34.18 | $34.18 | $84.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.87 / $47.67 / $338.32
| Facility | | $20.87 | $47.67 | $338.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.89 / $32.33 / $53.88
| Professional | | $29.89 | $32.33 | $53.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.89 / $32.33 / $48.69
| Professional | | $29.89 | $32.33 | $48.69 |