- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.56 / $10.56 / $10.56
| Facility | | $10.56 | $10.56 | $10.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.65 / $12.39 / $22.59
| Professional | | $7.65 | $12.39 | $22.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.48 / $21.66 / $30.44
| Professional | | $9.48 | $21.66 | $30.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.78 / $26.78 / $26.78
| Facility | | $26.78 | $26.78 | $26.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.43 / $21.43 / $29.02
| Professional | | $21.43 | $21.43 | $29.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.54 / $10.56 / $21.80
| Facility | | $5.54 | $10.56 | $21.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.56 / $14.79 / $33.00
| Professional | | $14.56 | $14.79 | $33.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.79 / $36.19 / $41.13
| Professional | | $32.79 | $36.19 | $41.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.40 / $14.09 / $37.01
| Professional | | $8.40 | $14.09 | $37.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.82 / $85.00 / $131.29
| Facility | | $45.82 | $85.00 | $131.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.60 / $204.83 / $204.83
| Professional | | $123.60 | $204.83 | $204.83 |