- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.86 / $14.86 / $222.48
| Facility | | $14.86 | $14.86 | $222.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.86 / $17.30 / $71.64
| Professional | | $14.86 | $17.30 | $71.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.85 / $21.99 / $46.33
| Professional | | $12.85 | $21.99 | $46.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.44 / $37.90 / $58.15
| Facility | | $32.44 | $37.90 | $58.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.54 / $37.13 / $42.19
| Professional | | $16.54 | $37.13 | $42.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.22 / $23.50 / $32.22
| Facility | | $17.22 | $23.50 | $32.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.22 / $23.50 / $32.22
| Facility | | $17.22 | $23.50 | $32.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.81 / $27.43 / $46.88
| Professional | | $14.81 | $27.43 | $46.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.02 / $55.00 / $85.00
| Professional | | $43.02 | $55.00 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.22 / $23.50 / $32.22
| Facility | | $17.22 | $23.50 | $32.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.38 / $37.07 / $50.84
| Professional | | $25.38 | $37.07 | $50.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.07 / $34.07 / $44.51
| Professional | | $34.07 | $34.07 | $44.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.76 / $37.76 / $49.42
| Professional | | $37.76 | $37.76 | $49.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.35 / $22.51 / $46.27
| Professional | | $14.35 | $22.51 | $46.27 |