- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.38 / $1,018.52 / $1,018.52
| Facility | | $24.38 | $1,018.52 | $1,018.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.63 / $24.38 / $24.38
| Professional | | $14.63 | $24.38 | $24.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.33 / $37.03 / $41.31
| Facility | | $22.33 | $37.03 | $41.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.38 / $20.88 / $22.27
| Professional | | $19.38 | $20.88 | $22.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.22 / $14.22 / $14.22
| Professional | | $14.22 | $14.22 | $14.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.92 / $24.38 / $40.36
| Facility | | $20.92 | $24.38 | $40.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.00 / $20.92 / $47.69
| Professional | | $18.00 | $20.92 | $47.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.80 / $37.70 / $54.90
| Professional | | $20.80 | $37.70 | $54.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.60 / $13.89 / $22.12
| Professional | | $10.60 | $13.89 | $22.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.52 / $85.00 / $132.24
| Facility | | $56.52 | $85.00 | $132.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.63 / $138.63 / $208.80
| Professional | | $138.63 | $138.63 | $208.80 |