- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.28 / $16.82 / $24.56
| Facility | | $12.28 | $16.82 | $24.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $12.28 / $13.51
| Professional | | $12.28 | $12.28 | $13.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.12 / $36.65 / $110.12
| Facility | | $17.12 | $36.65 | $110.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $12.89 / $88.81
| Professional | | $12.28 | $12.89 | $88.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.16 / $15.08 / $29.30
| Facility | | $13.16 | $15.08 | $29.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.28 / $12.28 / $17.13
| Facility | | $12.28 | $12.28 | $17.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $12.28 / $12.28
| Professional | | $12.28 | $12.28 | $12.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.28 / $53.00 / $8,090.00
| Facility | | $12.28 | $53.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $12.28 / $12.28
| Professional | | $12.28 | $12.28 | $12.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $12.28 / $14.21
| Professional | | $12.28 | $12.28 | $14.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $110.12 / $110.12
| Facility | | $75.00 | $110.12 | $110.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $13.02 / $88.81
| Professional | | $12.28 | $13.02 | $88.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $13.02 / $24.63
| Professional | | $12.28 | $13.02 | $24.63 |