- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.48 / $40.53 / $447.93
| Facility | | $15.48 | $40.53 | $447.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.48 / $17.10 / $17.55
| Professional | | $15.48 | $17.10 | $17.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.35 / $80.70 / $80.70
| Facility | | $42.35 | $80.70 | $80.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.61 / $13.55 / $19.62
| Professional | | $11.61 | $13.55 | $19.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.21 / $20.48 / $50.71
| Facility | | $13.21 | $20.48 | $50.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.31 / $14.22 / $27.88
| Professional | | $12.31 | $14.22 | $27.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.48 / $17.55 / $37.86
| Facility | | $15.48 | $17.55 | $37.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.94 / $27.72 / $36.00
| Professional | | $20.94 | $27.72 | $36.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.22 / $23.22 / $23.22
| Facility | | $23.22 | $23.22 | $23.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.68 / $13.52 / $26.40
| Professional | | $9.68 | $13.52 | $26.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.42 / $91.98 / $100.00
| Facility | | $64.42 | $91.98 | $100.00 |