- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.29 / $216.47 / $13,841.56
| Facility | | $36.29 | $216.47 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.88 / $11.88 / $115.74
| Professional | | $11.88 | $11.88 | $115.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $39.40 / $76.83
| Facility | | $30.20 | $39.40 | $76.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.68 / $27.35 / $29.52
| Professional | | $13.68 | $27.35 | $29.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.65 / $25.81 / $40.79
| Professional | | $20.65 | $25.81 | $40.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.80 / $35.86 / $86.10
| Facility | | $10.80 | $35.86 | $86.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.80 / $10.80 / $45.00
| Professional | | $10.80 | $10.80 | $45.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.04 / $31.97 / $48.77
| Facility | | $22.04 | $31.97 | $48.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.62 / $39.45 / $48.77
| Professional | | $21.62 | $39.45 | $48.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.26 / $10.80 / $36.00
| Professional | | $10.26 | $10.80 | $36.00 |