- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.13 / $72.50 / $132.76
| Facility | | $14.13 | $72.50 | $132.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.86 / $11.56 / $50.00
| Professional | | $6.86 | $11.56 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.56 / $8.99 / $18.28
| Professional | | $3.56 | $8.99 | $18.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.94 / $28.34 / $46.97
| Facility | | $21.94 | $28.34 | $46.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.77 / $7.77 / $9.07
| Professional | | $7.77 | $7.77 | $9.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.84 / $13.70 / $33.81
| Facility | | $8.84 | $13.70 | $33.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.15 / $9.48 / $18.59
| Professional | | $8.15 | $9.48 | $18.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.36 / $11.74 / $25.33
| Facility | | $10.36 | $11.74 | $25.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $18.54 / $24.00
| Professional | | $5.00 | $18.54 | $24.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.15 / $544.15 / $2,091.87
| Facility | | $544.15 | $544.15 | $2,091.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.48 / $9.03 / $17.66
| Professional | | $6.48 | $9.03 | $17.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.55 / $70.00 / $70.00
| Facility | | $42.55 | $70.00 | $70.00 |