- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.48 / $57.54 / $1,000.00
| Facility | | $11.48 | $57.54 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $19.05 / $33.88
| Professional | | $6.03 | $19.05 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $22.39 / $22.39
| Professional | | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $14.45 / $42.66
| Professional | | $8.91 | $14.45 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $21.38
| Professional | | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $23.44 / $24.55
| Professional | | $23.44 | $23.44 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.41 / $17.38 / $29.51
| Facility | | $7.41 | $17.38 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $812.83 / $1,949.84
| Facility | | $363.08 | $812.83 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $16.22 / $31.62
| Professional | | $7.08 | $16.22 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $147.91 / $199.53
| Professional | | $147.91 | $147.91 | $199.53 |