- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.73 / $561.44 / $2,807.20
| Facility | | $14.73 | $561.44 | $2,807.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.45 / $12.38 / $12.38
| Professional | | $4.45 | $12.38 | $12.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.20 / $6.73 / $24.78
| Facility | | $6.20 | $6.73 | $24.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $7.43 / $9.28
| Professional | | $2.27 | $7.43 | $9.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.04 / $12.38 / $13.12
| Facility | | $4.04 | $12.38 | $13.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.35 / $6.35 / $7.62
| Professional | | $6.35 | $6.35 | $7.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.35 / $6.35 / $6.35
| Professional | | $6.35 | $6.35 | $6.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $408.92 / $808.25 / $1,089.08
| Facility | | $408.92 | $808.25 | $1,089.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.40 / $11.06 / $11.12
| Professional | | $5.40 | $11.06 | $11.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $2.67 / $7.83
| Professional | | $2.27 | $2.67 | $7.83 |