- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,545.00 / $5,463.36 / $13,841.56
| Facility | | $1,545.00 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.66 / $5.66 / $10.41
| Professional | | $5.66 | $5.66 | $10.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.39 / $10.54 / $21.44
| Facility | | $8.39 | $10.54 | $21.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.71 / $13.42 / $14.40
| Professional | | $6.71 | $13.42 | $14.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.70 / $9.38 / $11.72
| Professional | | $2.70 | $9.38 | $11.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.38 / $10.19 / $80.00
| Facility | | $4.38 | $10.19 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.80 / $1.80 / $8.67
| Professional | | $1.80 | $1.80 | $8.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.70 / $4.97 / $11.92
| Facility | | $2.70 | $4.97 | $11.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.75 / $5.05 / $10.91
| Professional | | $3.75 | $5.05 | $10.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.71 / $1.80 / $8.67
| Professional | | $1.71 | $1.80 | $8.67 |