- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.00 / $3,388.44 / $4,570.88
| Facility | | $10.00 | $3,388.44 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $18.20 / $33.11
| Professional | | $6.03 | $18.20 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $21.38
| Professional | | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $32.36 / $33.11
| Professional | | $11.48 | $32.36 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $107.15 / $245.47
| Facility | | $91.20 | $107.15 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.59 / $12.59 / $33.88
| Professional | | $7.59 | $12.59 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $23.44 / $35.48
| Professional | | $7.76 | $23.44 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $28.84 / $41.69
| Professional | | $8.91 | $28.84 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $4,466.84 / $5,128.61
| Facility | | $1,071.52 | $4,466.84 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $16.22 / $31.62
| Professional | | $6.76 | $16.22 | $31.62 |