- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.62 / $158.49 / $1,905.46
| Facility | | $18.62 | $158.49 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $26.30 / $131.83
| Professional | | $10.96 | $26.30 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $12.88 / $40.74
| Professional | | $10.47 | $12.88 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.82 / $234.42 / $602.56
| Facility | | $128.82 | $234.42 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $42.66 / $100.00
| Professional | | $11.75 | $42.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $75.86 / $117.49
| Professional | | $60.26 | $75.86 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $60.26 / $131.83
| Professional | | $51.29 | $60.26 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $31.62 / $81.28
| Professional | | $9.77 | $31.62 | $81.28 |