- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.02 / $33.09 / $12,260.40
| Facility | | $23.02 | $33.09 | $12,260.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.01 / $23.02 / $23.67
| Professional | | $23.01 | $23.02 | $23.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.08 / $20.83 / $32.84
| Facility | | $13.08 | $20.83 | $32.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.10 / $20.10 / $21.31
| Facility | | $20.10 | $20.10 | $21.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.31 / $21.31 / $21.31
| Professional | | $21.31 | $21.31 | $21.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.86 / $23.83 / $75.00
| Facility | | $19.86 | $23.83 | $75.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.16 / $22.06 / $22.06
| Professional | | $21.16 | $22.06 | $22.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.31 / $21.31 / $22.84
| Professional | | $21.31 | $21.31 | $22.84 |