- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.72 / $104.85 / $2,168.00
| Facility | | $77.72 | $104.85 | $2,168.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.10 / $2.46 / $12.48
| Professional | | $2.10 | $2.46 | $12.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.46 / $8.57 / $9.09
| Facility | | $4.46 | $8.57 | $9.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.27 / $9.09 / $9.09
| Professional | | $7.27 | $9.09 | $9.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.62 / $32.25 / $77.58
| Facility | | $18.62 | $32.25 | $77.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.47 / $11.88 / $11.91
| Professional | | $9.47 | $11.88 | $11.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.91 / $30.78 / $61.09
| Facility | | $17.91 | $30.78 | $61.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.38 / $9.38 / $12.75
| Professional | | $9.38 | $9.38 | $12.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.34 / $13.62 / $514.29
| Facility | | $4.34 | $13.62 | $514.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.26 / $3.12 / $7.91
| Professional | | $1.26 | $3.12 | $7.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.53 / $3.71 / $11.36
| Professional | | $1.53 | $3.71 | $11.36 |