- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,776.00 / $5,866.00 / $16,467.00
| Facility | | $3,776.00 | $5,866.00 | $16,467.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $2.40 / $10.41
| Professional | | $2.40 | $2.40 | $10.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.47 / $18.47 / $19.73
| Facility | | $18.47 | $18.47 | $19.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.09 / $9.09 / $12.43
| Professional | | $9.09 | $9.09 | $12.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.05 / $25.60 / $51.84
| Facility | | $16.05 | $25.60 | $51.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.58 / $1.70 / $11.72
| Professional | | $1.58 | $1.70 | $11.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.70 / $6.68 / $9.17
| Facility | | $2.70 | $6.68 | $9.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $3.00 / $4.00
| Professional | | $3.00 | $3.00 | $4.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.65 / $1.65 / $2.38
| Professional | | $1.65 | $1.65 | $2.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.50 / $1.80 / $5.40
| Professional | | $1.50 | $1.80 | $5.40 |