- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $53.70 / $112.20
| Facility | | $20.42 | $53.70 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $18.20 / $91.20
| Professional | | $15.14 | $18.20 | $91.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.62 / $28.84 / $100.00
| Facility | | $18.62 | $28.84 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.51 / $20.42 / $42.66
| Professional | | $8.51 | $20.42 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $48.98 / $79.43
| Facility | | $39.81 | $48.98 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $19.05 / $25.70
| Professional | | $19.05 | $19.05 | $25.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.85 / $32.36 / $77.62
| Facility | | $15.85 | $32.36 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.79 / $24.55 / $34.67
| Professional | | $14.79 | $24.55 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.84 / $3,630.78 / $9,772.37
| Facility | | $28.84 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.51 / $29.51 / $34.67
| Professional | | $29.51 | $29.51 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $20.42 / $61.66
| Professional | | $20.42 | $20.42 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.20 / $26.30 / $102.33
| Facility | | $18.20 | $26.30 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.62 / $28.84 / $100.00
| Facility | | $18.62 | $28.84 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $20.42 / $42.66
| Professional | | $9.77 | $20.42 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.75 / $20.42 / $33.11
| Facility | | $11.75 | $20.42 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.17 / $16.98 / $47.86
| Professional | | $4.17 | $16.98 | $47.86 |