- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.81 / $1,347.40 / $9,872.00
| Facility | | $5.81 | $1,347.40 | $9,872.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.81 / $11.60 / $22.35
| Professional | | $5.81 | $11.60 | $22.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,974.00 / $2,971.00 / $7,022.00
| Facility | | $1,974.00 | $2,971.00 | $7,022.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.86 / $14.91 / $25.64
| Professional | | $8.86 | $14.91 | $25.64 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $9.01 / $17.55 / $28.12
| Professional | 50 | $9.01 | $17.55 | $28.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.75 / $15.83 / $25.98
| Professional | | $8.75 | $15.83 | $25.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.29 / $12.57 / $26.26
| Facility | | $7.29 | $12.57 | $26.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.31 / $14.33 / $27.23
| Professional | | $9.31 | $14.33 | $27.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.00 / $1,464.00 / $3,011.00
| Facility | | $658.00 | $1,464.00 | $3,011.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.20 / $22.10 / $31.19
| Professional | | $15.20 | $22.10 | $31.19 |