- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.55 / $18.30 / $33.36
| Facility | | $6.55 | $18.30 | $33.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.55 / $6.55 / $13.74
| Professional | | $6.55 | $6.55 | $13.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.08 / $15.49 / $100.00
| Facility | | $8.08 | $15.49 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $8.85 / $21.35
| Professional | | $5.25 | $8.85 | $21.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.61 / $24.57 / $42.95
| Facility | | $12.61 | $24.57 | $42.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $8.32 / $8.80
| Professional | | $8.32 | $8.32 | $8.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.18 / $13.15 / $30.21
| Facility | | $6.18 | $13.15 | $30.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.41 / $8.32 / $14.92
| Professional | | $5.41 | $8.32 | $14.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.93 / $3,472.00 / $9,239.00
| Facility | | $38.93 | $3,472.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.61 / $12.61 / $14.83
| Professional | | $12.61 | $12.61 | $14.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.85 / $12.27 / $31.55
| Professional | | $8.85 | $12.27 | $31.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.49 / $100.00 / $100.00
| Facility | | $15.49 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.25 / $5.31 / $14.83
| Professional | | $4.25 | $5.31 | $14.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.25 / $5.31 / $15.84
| Professional | | $4.25 | $5.31 | $15.84 |