- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.66 / $54.35 / $173.90
| Facility | | $11.66 | $54.35 | $173.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.03 / $10.84 / $15.86
| Professional | | $9.03 | $10.84 | $15.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $8.36 / $22.29
| Professional | | $6.03 | $8.36 | $22.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.65 / $23.38 / $60.00
| Facility | | $12.65 | $23.38 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.95 / $11.33 / $20.80
| Professional | | $5.95 | $11.33 | $20.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.34 / $24.66 / $39.27
| Facility | | $8.34 | $24.66 | $39.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.44 / $15.44 / $23.86
| Professional | | $8.44 | $15.44 | $23.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.57 / $11.62 / $12.78
| Professional | | $8.57 | $11.62 | $12.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.05 / $12.65 / $30.75
| Facility | | $12.05 | $12.65 | $30.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.05 / $18.07 / $33.14
| Facility | | $12.05 | $18.07 | $33.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.85 / $10.85 / $10.85
| Professional | | $10.85 | $10.85 | $10.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.86 / $19.88 / $33.14
| Facility | | $13.86 | $19.88 | $33.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.03 / $12.05 / $32.34
| Professional | | $9.03 | $12.05 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.05 / $6.03 / $14.46
| Professional | | $5.05 | $6.03 | $14.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.42 / $5.42 / $6.24
| Professional | | $5.42 | $5.42 | $6.24 |