- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.16 / $231.31 / $7,796.00
| Facility | | $7.16 | $231.31 | $7,796.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $6.99 / $70.56
| Professional | | $2.25 | $6.99 | $70.56 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $1.02 / $3.26 / $3.58
| Professional | 52 | $1.02 | $3.26 | $3.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $5.48 / $6.02
| Professional | | $2.02 | $5.48 | $6.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.69 / $116.14 / $220.61
| Facility | | $47.69 | $116.14 | $220.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $8.80 / $16.00
| Professional | | $2.25 | $8.80 | $16.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.54 / $5.89 / $12.55
| Professional | | $2.54 | $5.89 | $12.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.10 / $7.88 / $15.72
| Facility | | $2.10 | $7.88 | $15.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.00 / $1,221.00 / $3,585.00
| Facility | | $225.00 | $1,221.00 | $3,585.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.30 / $6.05 / $12.08
| Professional | | $4.30 | $6.05 | $12.08 |