- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.22 / $19.03 / $35.52
| Professional | | $15.22 | $19.03 | $35.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.58 / $25.37 / $61.90
| Facility | | $22.58 | $25.37 | $61.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $13.95 / $35.52
| Professional | | $5.00 | $13.95 | $35.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.56 / $25.37 / $25.37
| Facility | | $21.56 | $25.37 | $25.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $17.94 / $46.91
| Professional | | $12.88 | $17.94 | $46.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.18 / $120.51 / $120.51
| Facility | | $70.18 | $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 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.56 / $33.29 / $56.72
| Facility | | $21.56 | $33.29 | $56.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.37 / $25.37 / $31.71
| Professional | | $25.37 | $25.37 | $31.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.48 / $31.71 / $97.17
| Professional | | $16.48 | $31.71 | $97.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.82 / $33.29 / $65.95
| Facility | | $20.82 | $33.29 | $65.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.45 / $29.18 / $45.93
| Professional | | $13.45 | $29.18 | $45.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.22 / $18.16 / $55.81
| Professional | | $15.22 | $18.16 | $55.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.89 / $13.14 / $25.37
| Professional | | $9.89 | $13.14 | $25.37 |