- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.76 / $129.75 / $174.28
| Facility | | $13.76 | $129.75 | $174.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.76 / $15.35 / $15.62
| Professional | | $13.76 | $15.35 | $15.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.36 / $71.75 / $71.75
| Facility | | $36.36 | $71.75 | $71.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.74 / $11.18 / $14.00
| Professional | | $7.74 | $11.18 | $14.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.74 / $18.22 / $45.37
| Facility | | $11.74 | $18.22 | $45.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.98 / $12.76 / $24.78
| Professional | | $10.98 | $12.76 | $24.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.76 / $15.60 / $33.65
| Facility | | $13.76 | $15.60 | $33.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $24.64 / $33.00
| Professional | | $23.44 | $24.64 | $33.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.74 / $12.02 / $23.47
| Professional | | $7.74 | $12.02 | $23.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.43 / $82.56 / $100.00
| Facility | | $70.43 | $82.56 | $100.00 |