- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.03 / $86.82 / $131.75
| Facility | | $10.03 | $86.82 | $131.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.02 / $9.75 / $22.92
| Professional | | $8.02 | $9.75 | $22.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.62 / $6.70 / $9.30
| Professional | | $3.62 | $6.70 | $9.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.73 / $34.54 / $50.06
| Facility | | $25.73 | $34.54 | $50.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.72 / $12.72 / $13.68
| Professional | | $12.72 | $12.72 | $13.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.69 / $9.35 / $21.89
| Facility | | $8.69 | $9.35 | $21.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.89 / $15.28 / $19.23
| Professional | | $7.89 | $15.28 | $19.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.75 / $14.95 / $100.00
| Facility | | $9.75 | $14.95 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.62 / $7.74 / $16.73
| Professional | | $5.62 | $7.74 | $16.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.87 / $57.87 / $82.75
| Facility | | $57.87 | $57.87 | $82.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.62 / $6.70 / $8.69
| Professional | | $5.62 | $6.70 | $8.69 |