- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.37 / $44.37 / $44.37
| Facility | | $44.37 | $44.37 | $44.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.74 / $21.23 / $34.33
| Professional | | $13.74 | $21.23 | $34.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.22 / $20.07 / $46.83
| Facility | | $2.22 | $20.07 | $46.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.63 / $15.35 / $34.00
| Professional | | $4.63 | $15.35 | $34.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.08 / $23.17 / $39.47
| Facility | | $11.08 | $23.17 | $39.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.84 / $32.84 / $32.84
| Professional | | $32.84 | $32.84 | $32.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $2,000.00 / $3,900.00
| Professional | | $30.00 | $2,000.00 | $3,900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.33 / $384.07 / $524.42
| Facility | | $280.33 | $384.07 | $524.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.36 / $33.21 / $33.36
| Professional | | $28.36 | $33.21 | $33.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.57 / $8.28 / $12.34
| Professional | | $5.57 | $8.28 | $12.34 |