- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.82 / $32.47 / $53.21
| Facility | | $13.82 | $32.47 | $53.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.82 / $13.82 / $16.41
| Professional | | $13.82 | $13.82 | $16.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.91 / $6.91 / $18.34
| Professional | | $6.91 | $6.91 | $18.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.68 / $22.45 / $404.12
| Facility | | $14.68 | $22.45 | $404.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.92 / $37.49 / $474.47
| Professional | | $17.92 | $37.49 | $474.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.23 / $17.79 / $98.60
| Facility | | $11.23 | $17.79 | $98.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.23 / $19.82 / $24.78
| Professional | | $11.23 | $19.82 | $24.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.23 / $17.79 / $98.60
| Facility | | $11.23 | $17.79 | $98.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.23 / $11.23 / $11.23
| Professional | | $11.23 | $11.23 | $11.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.25 / $10.36 / $22.62
| Professional | | $7.25 | $10.36 | $22.62 |