- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $51.29 / $4,570.88
| Facility | | $12.02 | $51.29 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $12.02 / $19.50
| Professional | | $8.91 | $12.02 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $10.47 / $10.47
| Professional | | $10.47 | $10.47 | $10.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.13 / $11.75 / $19.50
| Facility | | $8.13 | $11.75 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $13.80 / $16.60
| Professional | | $12.30 | $13.80 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.48 / $12.02 / $12.02
| Facility | | $11.48 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $12.02
| Professional | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $15.14 / $32.36
| Facility | | $12.59 | $15.14 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Professional | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.48 / $12.02 / $26.30
| Facility | | $11.48 | $12.02 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $12.02 / $13.18
| Professional | | $11.48 | $12.02 | $13.18 |