- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.36 / $2,145.78 / $7,838.38
| Facility | | $33.36 | $2,145.78 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.25 / $3.60 / $12.48
| Professional | | $2.25 | $3.60 | $12.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.42 / $54.85 / $300.00
| Facility | | $15.42 | $54.85 | $300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.42 / $7.22 / $8.06
| Professional | | $5.42 | $7.22 | $8.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.95 / $1.95 / $1.95
| Facility | | $1.95 | $1.95 | $1.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.58 / $2.25 / $11.72
| Professional | | $1.58 | $2.25 | $11.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.65 / $10.28 / $10.28
| Professional | | $1.65 | $10.28 | $10.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.00 / $3.75 / $8.14
| Facility | | $3.00 | $3.75 | $8.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.58 / $2.46 / $3.00
| Professional | | $1.58 | $2.46 | $3.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.26 / $1.26 / $1.80
| Professional | | $1.26 | $1.26 | $1.80 |