- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.51 / $644.54 / $1,309.67
| Facility | | $31.51 | $644.54 | $1,309.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.59 / $31.22 / $108.00
| Professional | | $18.59 | $31.22 | $108.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.62 / $10.62 / $10.62
| Professional | | $10.62 | $10.62 | $10.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.86 / $24.45 / $27.11
| Facility | | $5.86 | $24.45 | $27.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.52 / $33.54 / $40.26
| Professional | | $29.52 | $33.54 | $40.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.31 / $30.01 / $30.01
| Facility | | $28.31 | $30.01 | $30.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.01 / $30.01 / $30.01
| Professional | | $30.01 | $30.01 | $30.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.10 / $34.65 / $61.90
| Facility | | $6.10 | $34.65 | $61.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.32 / $26.32 / $26.32
| Professional | | $26.32 | $26.32 | $26.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.01 / $30.01 / $30.01
| Professional | | $30.01 | $30.01 | $30.01 |