- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.66 / $60.00 / $104.88
| Facility | | $21.66 | $60.00 | $104.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $24.23 / $33.31
| Professional | | $21.38 | $24.23 | $33.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.12 / $82.37 / $130.53
| Facility | | $30.12 | $82.37 | $130.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.97 / $11.97 / $22.72
| Professional | | $11.97 | $11.97 | $22.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.68 / $26.35 / $73.38
| Facility | | $16.68 | $26.35 | $73.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.07 / $24.06 / $40.78
| Professional | | $16.07 | $24.06 | $40.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.66 / $33.08 / $51.81
| Facility | | $21.66 | $33.08 | $51.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.10 / $37.04 / $90.00
| Professional | | $19.10 | $37.04 | $90.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.08 / $33.08 / $33.08
| Facility | | $33.08 | $33.08 | $33.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.97 / $15.15 / $21.09
| Professional | | $11.97 | $15.15 | $21.09 |