- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $36.31 / $58.88
| Facility | | $12.88 | $36.31 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $12.88 / $61.66
| Professional | | $8.91 | $12.88 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $19.50 / $100.00
| Facility | | $12.59 | $19.50 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $13.80 / $29.51
| Professional | | $6.31 | $13.80 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.54 / $34.67 / $54.95
| Facility | | $27.54 | $34.67 | $54.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $13.18 / $17.78
| Professional | | $13.18 | $13.18 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $21.88 / $53.70
| Facility | | $10.72 | $21.88 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $16.98 / $23.44
| Professional | | $10.00 | $16.98 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.50 / $3,630.78 / $9,772.37
| Facility | | $19.50 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $19.95 / $23.44
| Professional | | $19.95 | $19.95 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $13.80 / $41.69
| Professional | | $13.80 | $13.80 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $19.50 / $100.00
| Facility | | $12.59 | $19.50 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.61 / $13.80 / $29.51
| Professional | | $6.61 | $13.80 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.94 / $13.80 / $23.44
| Facility | | $7.94 | $13.80 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $11.75 / $33.11
| Professional | | $6.31 | $11.75 | $33.11 |