- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.23 / $43.38 / $70.76
| Facility | | $22.23 | $43.38 | $70.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.82 / $22.23 / $23.31
| Professional | | $17.82 | $22.23 | $23.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.71 / $37.95 / $47.98
| Facility | | $31.71 | $37.95 | $47.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.53 / $64.84 / $125.08
| Facility | | $30.53 | $64.84 | $125.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.82 / $33.04 / $41.30
| Professional | | $29.82 | $33.04 | $41.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.11 / $37.95 / $100.00
| Professional | | $27.11 | $37.95 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.56 / $18.60 / $27.11
| Professional | | $13.56 | $18.60 | $27.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.62 / $27.11 / $32.53
| Facility | | $18.62 | $27.11 | $32.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.39 / $16.27 / $27.92
| Professional | | $11.39 | $16.27 | $27.92 |