- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.60 / $77.34 / $134.25
| Facility | | $13.60 | $77.34 | $134.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.38 / $6.72 / $13.95
| Professional | | $5.38 | $6.72 | $13.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $5.38 / $15.00
| Professional | | $2.37 | $5.38 | $15.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.96 / $26.38 / $26.38
| Facility | | $17.96 | $26.38 | $26.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.75 / $7.75 / $10.76
| Professional | | $7.75 | $7.75 | $10.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.37 / $7.12 / $22.24
| Facility | | $4.37 | $7.12 | $22.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.03 / $6.69 / $12.71
| Professional | | $4.03 | $6.69 | $12.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.25 / $6.46 / $12.38
| Facility | | $5.25 | $6.46 | $12.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.61 / $9.06 / $12.00
| Professional | | $8.61 | $9.06 | $12.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,712.42 / $2,901.40 / $8,240.34
| Facility | | $2,712.42 | $2,901.40 | $8,240.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.17 / $6.19 / $8.63
| Professional | | $5.17 | $6.19 | $8.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.09 / $60.00 / $60.00
| Facility | | $21.09 | $60.00 | $60.00 |