- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.08 / $3,235.94 / $8,912.51
| Facility | | $7.08 | $3,235.94 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $18.20 / $32.36
| Professional | | $7.08 | $18.20 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $18.20 / $38.90
| Professional | | $7.76 | $18.20 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $707.95 / $1,047.13
| Professional | | $6.03 | $707.95 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.60 / $16.60 / $16.60
| Facility | | $16.60 | $16.60 | $16.60 |
- 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
- $21.88 / $28.84 / $33.88
| Professional | | $21.88 | $28.84 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $22.39 / $23.44
| Professional | | $22.39 | $22.39 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.08 / $16.60 / $32.36
| Facility | | $7.08 | $16.60 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $20.89 / $20.89
| Professional | | $20.89 | $20.89 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.24 / $10.23 / $4,073.80
| Facility | | $7.24 | $10.23 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $28.84 / $4,073.80
| Professional | | $16.98 | $28.84 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $1,202.26 / $2,454.71
| Facility | | $229.09 | $1,202.26 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $15.49 / $36.31
| Professional | | $6.76 | $15.49 | $36.31 |