- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $69.18 / $114.82
| Facility | | $30.20 | $69.18 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $30.20 / $46.77
| Professional | | $20.89 | $30.20 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.90 / $38.90 / $100.00
| Facility | | $38.90 | $38.90 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $15.49 / $66.07
| Professional | | $15.49 | $15.49 | $66.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.91 / $38.90 / $38.90
| Facility | | $22.91 | $38.90 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.18 / $38.90 / $38.90
| Professional | | $28.18 | $38.90 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.12 / $83.18 / $100.00
| Facility | | $25.12 | $83.18 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $186.21 / $186.21
| Professional | | $22.91 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.90 / $50.12 / $107.15
| Facility | | $30.90 | $50.12 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $22.91 / $74.13
| Professional | | $15.49 | $22.91 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $10.72 / $10.72
| Facility | | $10.72 | $10.72 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $33.11 / $42.66
| Professional | | $10.72 | $33.11 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.11 / $52.48 / $281.84
| Facility | | $33.11 | $52.48 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.90 / $72.44 / $50,118.72
| Facility | | $38.90 | $72.44 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.23 / $34.67 / $46.77
| Facility | | $10.23 | $34.67 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $21.88 / $57.54
| Professional | | $16.22 | $21.88 | $57.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $13.18 / $45.71
| Facility | | $10.72 | $13.18 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $33.11 / $46.77
| Professional | | $10.72 | $33.11 | $46.77 |