- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $12.17 / $21.00
| Professional | | $8.13 | $12.17 | $21.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.90 / $35.86 / $39.86
| Facility | | $29.90 | $35.86 | $39.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.73 / $8.51 / $31.82
| Professional | | $6.73 | $8.51 | $31.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.44 / $16.60 / $16.60
| Facility | | $15.44 | $16.60 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $16.60 / $16.60
| Professional | | $16.60 | $16.60 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.77 / $30.77 / $30.77
| Facility | | $30.77 | $30.77 | $30.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.44 / $9.44 / $9.44
| Professional | | $9.44 | $9.44 | $9.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.93 / $26.91 / $43.25
| Professional | | $20.93 | $26.91 | $43.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.42 / $11.42 / $11.42
| Facility | | $11.42 | $11.42 | $11.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.42 / $11.42 / $11.42
| Professional | | $11.42 | $11.42 | $11.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.77 / $30.77 / $597.00
| Facility | | $30.77 | $30.77 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.44 / $9.44 / $34.47
| Professional | | $9.44 | $9.44 | $34.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.63 / $9.94 / $17.09
| Professional | | $6.63 | $9.94 | $17.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.42 / $12.46 / $19.93
| Professional | | $11.42 | $12.46 | $19.93 |