- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.38 / $61.66 / $100.00
| Facility | | $21.38 | $61.66 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $19.05 / $40.74
| Professional | | $15.85 | $19.05 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $158.49 / $5,011.87
| Facility | | $120.23 | $158.49 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $17.78 / $22.39
| Professional | | $17.78 | $17.78 | $22.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.14 / $34.67 / $77.62
| Facility | | $15.14 | $34.67 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $25.70 / $39.81
| Professional | | $14.13 | $25.70 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $22.91 / $33.11
| Professional | | $10.72 | $22.91 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.91 / $22.91 / $22.91
| Facility | | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $25.12 / $38.90
| Professional | | $22.39 | $25.12 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $54.95 / $54.95
| Facility | | $54.95 | $54.95 | $54.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.38 / $58.88 / $100.00
| Facility | | $21.38 | $58.88 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $20.89 / $83.18
| Professional | | $16.60 | $20.89 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $22.91
| Facility | | $21.38 | $21.38 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $32.36
| Professional | | $21.38 | $21.38 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.14 / $22.91 / $26.92
| Facility | | $15.14 | $22.91 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $16.60 / $39.81
| Professional | | $10.23 | $16.60 | $39.81 |