- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $67.61 / $8,511.38
| Facility | | $12.88 | $67.61 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $57.54 / $67.61
| Professional | | $12.88 | $57.54 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $40.74
| Professional | | $32.36 | $32.36 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.49 / $25.70 / $102.33
| Facility | | $13.49 | $25.70 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $35.48 / $41.69
| Professional | | $19.95 | $35.48 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $2,041.74
| Facility | | $1,819.70 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $37.15 / $81.28
| Professional | | $21.38 | $37.15 | $81.28 |