- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $602.56 / $2,691.53
| Facility | | $34.67 | $602.56 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $75.86 / $1,000.00
| Professional | | $16.98 | $75.86 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.91 / $25.12 / $29.51
| Facility | | $22.91 | $25.12 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $22.39 / $75.86
| Professional | | $12.30 | $22.39 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $77.62 / $181.97
| Facility | | $20.42 | $77.62 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $30.20 / $77.62
| Professional | | $12.88 | $30.20 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $30.20 / $30.20
| Facility | | $10.96 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $24.55 / $56.23
| Professional | | $12.88 | $24.55 | $56.23 |