- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.13 / $5,684.42 / $8,011.65
| Facility | | $21.13 | $5,684.42 | $8,011.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.56 / $11.77 / $21.13
| Professional | | $6.56 | $11.77 | $21.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.35 / $9.35 / $9.35
| Professional | | $9.35 | $9.35 | $9.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $45.00 / $60.00
| Professional | | $8.32 | $45.00 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.29 / $41.21 / $59.16
| Facility | | $27.29 | $41.21 | $59.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.80 / $7.36 / $9.66
| Professional | | $5.80 | $7.36 | $9.66 |