- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.21 / $22.21 / $22.21
| Facility | | $22.21 | $22.21 | $22.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.21 / $24.49 / $32.57
| Professional | | $22.21 | $24.49 | $32.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.00 / $105.80 / $242.56
| Facility | | $21.00 | $105.80 | $242.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.98 / $36.39 / $49.65
| Professional | | $20.98 | $36.39 | $49.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.65 / $39.20 / $39.20
| Professional | | $35.65 | $39.20 | $39.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.33 / $36.33 / $36.33
| Facility | | $36.33 | $36.33 | $36.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.52 / $26.52 / $60.38
| Professional | | $26.52 | $26.52 | $60.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.17 / $41.17 / $43.23
| Professional | | $41.17 | $41.17 | $43.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.97 / $32.97 / $32.97
| Professional | | $32.97 | $32.97 | $32.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.80 / $242.56 / $242.56
| Facility | | $105.80 | $242.56 | $242.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.35 / $25.37 / $49.65
| Professional | | $19.35 | $25.37 | $49.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.04 / $23.01 / $26.87
| Facility | | $0.04 | $23.01 | $26.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.68 / $26.31 / $49.65
| Professional | | $19.68 | $26.31 | $49.65 |