- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $32.36
| Facility | | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $50.12 / $1,230.27
| Professional | | $30.20 | $50.12 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.95 / $52.48 / $104.71
| Facility | | $19.95 | $52.48 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $72.44 / $2,238.72
| Professional | | $30.20 | $72.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $977.24
| Professional | | $575.44 | $575.44 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $691.83 / $1,000.00
| Professional | | $363.08 | $691.83 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $64.57 / $91.20
| Professional | | $41.69 | $64.57 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.95 / $52.48 / $104.71
| Facility | | $19.95 | $52.48 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $72.44 / $2,238.72
| Professional | | $30.20 | $72.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $70.79 / $104.71
| Professional | | $44.67 | $70.79 | $104.71 |