- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.98 / $21.82 / $21.82
| Facility | | $15.98 | $21.82 | $21.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.87 / $20.30 / $42.64
| Professional | | $16.87 | $20.30 | $42.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.10 / $47.10 / $47.10
| Professional | | $47.10 | $47.10 | $47.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.83 / $31.71 / $67.06
| Professional | | $22.83 | $31.71 | $67.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.74 / $22.38 / $49.20
| Professional | | $11.74 | $22.38 | $49.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.83 / $39.00 / $53.02
| Facility | | $22.83 | $39.00 | $53.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.98 / $23.98 / $23.98
| Professional | | $23.98 | $23.98 | $23.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.48 / $25.37 / $81.22
| Professional | | $16.48 | $25.37 | $81.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.22 / $22.83 / $47.76
| Professional | | $15.22 | $22.83 | $47.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.51 / $120.51 / $120.51
| Facility | | $120.51 | $120.51 | $120.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,796.55 / $2,796.55 / $2,796.55
| Professional | | $2,796.55 | $2,796.55 | $2,796.55 |