- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.12 / $42.66 / $112.20
| Facility | | $25.12 | $42.66 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $21.88 / $44.67
| Professional | | $15.85 | $21.88 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $22.91 / $22.91
| Professional | | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.92 / $26.92 / $93.33
| Facility | | $26.92 | $26.92 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $20.42 / $50.12
| Professional | | $10.72 | $20.42 | $50.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.62 / $33.88 / $38.02
| Facility | | $31.62 | $33.88 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.44 / $50.12 / $100.00
| Facility | | $23.44 | $50.12 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $26.92 / $35.48
| Professional | | $10.47 | $26.92 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.50 / $45.71 / $151.36
| Facility | | $19.50 | $45.71 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $15.14 / $29.51
| Professional | | $11.22 | $15.14 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.23 / $26.92 / $32.36
| Facility | | $10.23 | $26.92 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $15.14 / $31.62
| Professional | | $11.22 | $15.14 | $31.62 |