- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.04 / $17.23 / $52.31
| Facility | | $16.04 | $17.23 | $52.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.33 / $16.04 / $22.06
| Professional | | $13.33 | $16.04 | $22.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.83 / $83.64 / $83.64
| Facility | | $41.83 | $83.64 | $83.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.04 / $23.52 / $52.69
| Professional | | $17.04 | $23.52 | $52.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.23 / $27.94 / $52.49
| Facility | | $15.23 | $27.94 | $52.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.31 / $18.61 / $40.18
| Professional | | $9.31 | $18.61 | $40.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.04 / $37.00 / $52.92
| Facility | | $16.04 | $37.00 | $52.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.62 / $21.62 / $28.72
| Professional | | $21.62 | $21.62 | $28.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.03 / $13.03 / $21.15
| Professional | | $13.03 | $13.03 | $21.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.02 / $14.01 / $28.02
| Professional | | $10.02 | $14.01 | $28.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.72 / $95.52 / $150.00
| Facility | | $36.72 | $95.52 | $150.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.86 / $203.86 / $203.86
| Professional | | $203.86 | $203.86 | $203.86 |