- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.64 / $250.00 / $256.25
| Facility | | $33.64 | $250.00 | $256.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.05 / $36.35 / $36.35
| Professional | | $13.05 | $36.35 | $36.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.54 / $19.76 / $72.72
| Facility | | $14.54 | $19.76 | $72.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.71 / $21.48 / $26.85
| Professional | | $17.71 | $21.48 | $26.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.52 / $36.35 / $38.53
| Facility | | $17.52 | $36.35 | $38.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.64 / $19.57 / $22.37
| Professional | | $18.64 | $19.57 | $22.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.64 / $18.64 / $18.64
| Professional | | $18.64 | $18.64 | $18.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.96 / $40.08 / $67.09
| Facility | | $27.96 | $40.08 | $67.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.84 / $32.01 / $32.79
| Professional | | $15.84 | $32.01 | $32.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.83 / $7.83 / $22.37
| Professional | | $7.83 | $7.83 | $22.37 |