- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.81 / $52.17 / $150.94
| Facility | | $26.81 | $52.17 | $150.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.81 / $27.83 / $33.94
| Professional | | $26.81 | $27.83 | $33.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.13 / $30.55 / $35.67
| Facility | | $21.13 | $30.55 | $35.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.76 / $28.44 / $38.46
| Professional | | $16.76 | $28.44 | $38.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.94 / $47.52 / $56.00
| Facility | | $33.94 | $47.52 | $56.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.32 / $44.12 / $67.88
| Professional | | $36.32 | $44.12 | $67.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.06 / $25.90 / $50.00
| Facility | | $22.06 | $25.90 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.17 / $39.24 / $203.83
| Professional | | $17.17 | $39.24 | $203.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.67 / $18.67 / $18.67
| Professional | | $18.67 | $18.67 | $18.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.65 / $27.71 / $47.43
| Professional | | $13.65 | $27.71 | $47.43 |