- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.44 / $20.25 / $24.04
| Professional | | $17.44 | $20.25 | $24.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.53 / $21.04 / $44.92
| Professional | | $17.53 | $21.04 | $44.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.26 / $30.26 / $30.26
| Facility | | $30.26 | $30.26 | $30.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.34 / $27.04 / $54.44
| Professional | | $12.34 | $27.04 | $54.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.22 / $18.52 / $26.18
| Facility | | $13.22 | $18.52 | $26.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.00 / $28.00 / $28.00
| Professional | | $28.00 | $28.00 | $28.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.31 / $28.83 / $34.54
| Professional | | $23.31 | $28.83 | $34.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.73 / $20.35 / $47.53
| Professional | | $12.73 | $20.35 | $47.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $93.77 / $93.77
| Facility | | $50.00 | $93.77 | $93.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.74 / $151.05 / $176.48
| Professional | | $117.74 | $151.05 | $176.48 |