- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.00 / $261.14 / $8,890.40
| Facility | | $117.00 | $261.14 | $8,890.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.10 / $19.78 / $63.32
| Professional | | $12.10 | $19.78 | $63.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.45 / $16.32 / $24.26
| Professional | | $12.45 | $16.32 | $24.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.02 / $13.02 / $13.02
| Facility | | $13.02 | $13.02 | $13.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.82 / $34.82 / $57.08
| Professional | | $15.82 | $34.82 | $57.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.25 / $19.60 / $30.00
| Facility | | $12.25 | $19.60 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.73 / $18.14 / $25.92
| Professional | | $14.73 | $18.14 | $25.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.00 / $1,464.00 / $2,720.00
| Facility | | $730.00 | $1,464.00 | $2,720.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.00 / $21.76 / $39.26
| Professional | | $13.00 | $21.76 | $39.26 |