- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.16 / $12.16 / $12.16
| Facility | | $12.16 | $12.16 | $12.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.74 / $13.84 / $60.08
| Professional | | $10.74 | $13.84 | $60.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.89 / $21.52 / $42.89
| Professional | | $12.89 | $21.52 | $42.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.78 / $58.78 / $71.34
| Facility | | $58.78 | $58.78 | $71.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.57 / $26.48 / $33.40
| Professional | | $10.57 | $26.48 | $33.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.88 / $15.36 / $132.19
| Facility | | $10.88 | $15.36 | $132.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.34 / $15.36 / $132.19
| Facility | | $10.34 | $15.36 | $132.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.95 / $22.95 / $1,889.17
| Professional | | $12.95 | $22.95 | $1,889.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.88 / $38.77 / $70.00
| Professional | | $34.88 | $38.77 | $70.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.88 / $15.36 / $63.85
| Facility | | $10.88 | $15.36 | $63.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.54 / $32.03 / $45.44
| Professional | | $15.54 | $32.03 | $45.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.02 / $1,020.06 / $1,889.17
| Professional | | $20.02 | $1,020.06 | $1,889.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $18.05 / $40.36
| Professional | | $17.05 | $18.05 | $40.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.80 / $18.05 / $54.64
| Professional | | $12.80 | $18.05 | $54.64 |