- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.55 / $59.93 / $143.78
| Facility | | $19.55 | $59.93 | $143.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.14 / $24.89 / $46.96
| Professional | | $18.14 | $24.89 | $46.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.49 / $14.46 / $14.46
| Professional | | $12.49 | $14.46 | $14.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.85 / $42.48 / $100.00
| Facility | | $21.85 | $42.48 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.28 / $18.94 / $35.90
| Professional | | $10.28 | $18.94 | $35.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.40 / $42.62 / $60.89
| Facility | | $14.40 | $42.62 | $60.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.46 / $27.03 / $41.39
| Professional | | $14.46 | $27.03 | $41.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.81 / $20.07 / $22.08
| Professional | | $14.81 | $20.07 | $22.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.81 / $22.89 / $45.94
| Facility | | $20.81 | $22.89 | $45.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.81 / $31.21 / $57.23
| Facility | | $20.81 | $31.21 | $57.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.73 / $18.73 / $18.73
| Professional | | $18.73 | $18.73 | $18.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.93 / $34.34 / $57.23
| Facility | | $23.93 | $34.34 | $57.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.61 / $20.81 / $56.59
| Professional | | $15.61 | $20.81 | $56.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.74 / $8.74 / $20.81
| Professional | | $8.74 | $8.74 | $20.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.36 / $9.36 / $10.78
| Professional | | $9.36 | $9.36 | $10.78 |