- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.06 / $37.51 / $11,885.59
| Facility | | $22.06 | $37.51 | $11,885.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.30 / $22.06 / $29.26
| Professional | | $21.30 | $22.06 | $29.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.01 / $110.32 / $424.68
| Facility | | $48.01 | $110.32 | $424.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.43 / $28.72 / $28.72
| Professional | | $25.43 | $28.72 | $28.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.31 / $21.31 / $21.31
| Facility | | $21.31 | $21.31 | $21.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.31 / $21.31 / $21.31
| Professional | | $21.31 | $21.31 | $21.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.31 / $35.57 / $65.40
| Professional | | $21.31 | $35.57 | $65.40 |
- 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
- $27.70 / $27.70 / $27.70
| Professional | | $27.70 | $27.70 | $27.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.31 / $21.31 / $23.36
| Professional | | $21.31 | $21.31 | $23.36 |