- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,551.00 / $5,503.00 / $10,651.00
| Facility | | $2,551.00 | $5,503.00 | $10,651.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.71 / $8.24 / $17.66
| Professional | | $5.71 | $8.24 | $17.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.21 / $16.47 / $29.16
| Professional | | $13.21 | $16.47 | $29.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.95 / $9.52 / $13.67
| Professional | | $7.95 | $9.52 | $13.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.98 / $8.39 / $13.21
| Facility | | $6.98 | $8.39 | $13.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.34 / $9.93 / $13.14
| Professional | | $7.34 | $9.93 | $13.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.24 / $6.93 / $8.36
| Professional | | $6.24 | $6.93 | $8.36 |