- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.23 / $2,106.02 / $2,206.08
| Facility | | $15.23 | $2,106.02 | $2,206.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.67 / $13.68 / $13.85
| Professional | | $12.67 | $13.68 | $13.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.57 / $22.80 / $25.34
| Facility | | $18.57 | $22.80 | $25.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.27 / $20.27 / $22.80
| Professional | | $20.27 | $20.27 | $22.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.73 / $20.27 / $50.67
| Facility | | $13.73 | $20.27 | $50.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.17 / $24.26 / $81.41
| Professional | | $8.17 | $24.26 | $81.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,719.65 / $1,719.65 / $2,095.55
| Facility | | $1,719.65 | $1,719.65 | $2,095.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.09 / $7.09 / $7.09
| Facility | | $7.09 | $7.09 | $7.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.60 / $8.31 / $19.79
| Professional | | $7.60 | $8.31 | $19.79 |