- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.78 / $15.15 / $1,548.54
| Facility | | $4.78 | $15.15 | $1,548.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.78 / $4.78 / $4.78
| Professional | | $4.78 | $4.78 | $4.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.90 / $370.01 / $1,344.24
| Facility | | $249.90 | $370.01 | $1,344.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.56 / $435.72 / $544.65
| Professional | | $9.56 | $435.72 | $544.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.11 / $214.58 / $423.76
| Professional | | $203.11 | $214.58 | $423.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.00 / $70.00 / $70.00
| Professional | | $70.00 | $70.00 | $70.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.63 / $357.63 / $536.45
| Facility | | $357.63 | $357.63 | $536.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.17 / $150.19 / $465.47
| Professional | | $125.17 | $150.19 | $465.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.25 / $214.58 / $214.58
| Professional | | $185.25 | $214.58 | $214.58 |