- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.36 / $3,038.00 / $4,387.00
| Facility | | $10.36 | $3,038.00 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.10 / $8.36 / $11.14
| Professional | | $7.10 | $8.36 | $11.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.52 / $12.48 / $17.48
| Professional | | $8.52 | $12.48 | $17.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.81 / $6.71 / $30.00
| Professional | | $5.81 | $6.71 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.97 / $296.17 / $431.61
| Facility | | $230.97 | $296.17 | $431.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.04 / $15.33 / $18.03
| Professional | | $12.04 | $15.33 | $18.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.90 / $9.43 / $12.92
| Professional | | $6.90 | $9.43 | $12.92 |