- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.10 / $49.93 / $115.24
| Facility | | $12.10 | $49.93 | $115.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.79 / $11.45 / $17.67
| Professional | | $10.79 | $11.45 | $17.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.72 / $8.94 / $21.88
| Professional | | $7.72 | $8.94 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.51 / $35.39 / $100.00
| Facility | | $13.51 | $35.39 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.36 / $11.58 / $22.20
| Professional | | $6.36 | $11.58 | $22.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.91 / $23.47 / $37.67
| Facility | | $8.91 | $23.47 | $37.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.94 / $16.97 / $25.81
| Professional | | $8.94 | $16.97 | $25.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.16 / $12.42 / $13.66
| Professional | | $9.16 | $12.42 | $13.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.87 / $13.51 / $28.41
| Facility | | $12.87 | $13.51 | $28.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.58 / $12.87 / $12.87
| Facility | | $11.58 | $12.87 | $12.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.58 / $11.58 / $11.58
| Professional | | $11.58 | $11.58 | $11.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.80 / $21.24 / $35.39
| Facility | | $14.80 | $21.24 | $35.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.60 / $12.87 / $35.03
| Professional | | $9.60 | $12.87 | $35.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.72 / $8.30 / $14.41
| Professional | | $7.72 | $8.30 | $14.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.67 / $6.67 / $6.67
| Professional | | $6.67 | $6.67 | $6.67 |