- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.48 / $3,000.00 / $11,550.00
| Facility | | $10.48 | $3,000.00 | $11,550.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.82 / $10.48 / $21.28
| Professional | | $5.82 | $10.48 | $21.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.50 / $10.50 / $10.50
| Professional | | $10.50 | $10.50 | $10.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.40 / $11.74 / $21.77
| Professional | | $6.40 | $11.74 | $21.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.00 / $1,716.00 / $2,887.00
| Facility | | $1,128.00 | $1,716.00 | $2,887.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.50 / $10.86 / $21.02
| Professional | | $9.50 | $10.86 | $21.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $10.95 / $20.31
| Professional | | $5.75 | $10.95 | $20.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.00 / $1,950.00 / $4,970.00
| Facility | | $366.00 | $1,950.00 | $4,970.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.05 / $14.15 / $24.78
| Professional | | $10.05 | $14.15 | $24.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.62 / $10.98 / $10.98
| Professional | | $5.62 | $10.98 | $10.98 |