- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.22 / $52.71 / $234.47
| Facility | | $43.22 | $52.71 | $234.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.64 / $48.49 / $52.71
| Professional | | $41.64 | $48.49 | $52.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.97 / $4.97 / $4.97
| Facility | | $4.97 | $4.97 | $4.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.22 / $4.97 / $4.97
| Professional | | $4.22 | $4.97 | $4.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.71 / $84.34 / $41,999.58
| Facility | | $52.71 | $84.34 | $41,999.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.98 / $73.79 / $977.98
| Professional | | $57.98 | $73.79 | $977.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.26 / $40.22 / $63.25
| Facility | | $34.26 | $40.22 | $63.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.29 / $75.89 / $254.06
| Professional | | $59.29 | $75.89 | $254.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.14 / $31.63 / $52.71
| Professional | | $22.14 | $31.63 | $52.71 |