- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.85 / $4,090.00 / $10,492.00
| Facility | | $7.85 | $4,090.00 | $10,492.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.11 / $10.94 / $27.75
| Professional | | $6.11 | $10.94 | $27.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,788.00 / $6,273.00 / $10,432.00
| Facility | | $3,788.00 | $6,273.00 | $10,432.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.51 / $12.77 / $31.17
| Professional | | $7.51 | $12.77 | $31.17 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $11.26 / $18.64 / $46.75
| Professional | 50 | $11.26 | $18.64 | $46.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $50.00
| Facility | | $50.00 | $50.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.41 / $16.79 / $29.40
| Professional | | $8.41 | $16.79 | $29.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.65 / $26.65 / $27.84
| Professional | | $22.65 | $26.65 | $27.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,347.00 / $3,983.00 / $6,832.00
| Facility | | $1,347.00 | $3,983.00 | $6,832.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.43 / $20.02 / $30.17
| Professional | | $12.43 | $20.02 | $30.17 |