- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.32 / $58.40 / $142.27
| Facility | | $16.32 | $58.40 | $142.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.33 / $12.30 / $22.33
| Professional | | $6.33 | $12.30 | $22.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.21 / $9.50 / $9.50
| Professional | | $8.21 | $9.50 | $9.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.36 / $37.61 / $100.00
| Facility | | $14.36 | $37.61 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.75 / $12.45 / $23.60
| Professional | | $6.75 | $12.45 | $23.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.46 / $28.00 / $45.34
| Facility | | $9.46 | $28.00 | $45.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.47 / $17.55 / $27.27
| Professional | | $9.47 | $17.55 | $27.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.74 / $13.20 / $14.52
| Professional | | $9.74 | $13.20 | $14.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.68 / $15.05 / $34.85
| Facility | | $13.68 | $15.05 | $34.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.31 / $13.68 / $13.68
| Facility | | $12.31 | $13.68 | $13.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.31 / $12.31 / $12.31
| Professional | | $12.31 | $12.31 | $12.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.73 / $22.57 / $37.61
| Facility | | $15.73 | $22.57 | $37.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.26 / $13.68 / $36.83
| Professional | | $10.26 | $13.68 | $36.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $5.75 / $15.32
| Professional | | $5.75 | $5.75 | $15.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.09 / $7.09 / $7.09
| Professional | | $7.09 | $7.09 | $7.09 |