- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.04 / $163.36
| Facility | | $0.02 | $0.04 | $163.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.00 / $184.00 / $184.00
| Professional | | $184.00 | $184.00 | $184.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.04 / $4.84 / $34.32
| Professional | | $4.04 | $4.84 | $34.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.43 / $24.10 / $37.86
| Facility | | $20.43 | $24.10 | $37.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.79 / $23.79 / $23.79
| Professional | | $23.79 | $23.79 | $23.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.56 / $54.56 / $54.56
| Facility | | $54.56 | $54.56 | $54.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.39 / $35.04 / $44.06
| Professional | | $11.39 | $35.04 | $44.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.06 / $42.26 / $112.04
| Facility | | $26.06 | $42.26 | $112.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.16 / $14.45 / $39.53
| Professional | | $10.16 | $14.45 | $39.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.16 / $14.51 / $39.53
| Professional | | $10.16 | $14.51 | $39.53 |