- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.74 / $10.74 / $10.74
| Facility | | $10.74 | $10.74 | $10.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $14.81 / $58.00
| Professional | | $10.74 | $14.81 | $58.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.34 / $117.78 / $117.78
| Facility | | $47.34 | $117.78 | $117.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.10 / $12.82 / $282.97
| Professional | | $10.10 | $12.82 | $282.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $34.77 / $44.36
| Facility | | $30.20 | $34.77 | $44.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.32 / $23.32 / $23.67
| Professional | | $23.32 | $23.32 | $23.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.51 / $9.51 / $10.53
| Professional | | $9.51 | $9.51 | $10.53 |
- 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
- $19.00 / $19.00 / $19.00
| Professional | | $19.00 | $19.00 | $19.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.34 / $117.78 / $117.78
| Facility | | $47.34 | $117.78 | $117.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.88 / $12.82 / $282.97
| Professional | | $9.88 | $12.82 | $282.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.88 / $12.82 / $35.92
| Professional | | $9.88 | $12.82 | $35.92 |