- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.14 / $41.69 / $67.61
| Facility | | $15.14 | $41.69 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $15.14 / $70.79
| Professional | | $10.96 | $15.14 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.45 / $22.39 / $100.00
| Facility | | $14.45 | $22.39 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $15.85 / $33.88
| Professional | | $6.76 | $15.85 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.62 / $39.81 / $56.23
| Facility | | $31.62 | $39.81 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $15.14 / $20.42
| Professional | | $15.14 | $15.14 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $25.12 / $61.66
| Facility | | $12.59 | $25.12 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $19.50 / $26.92
| Professional | | $11.75 | $19.50 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.91 / $3,630.78 / $9,772.37
| Facility | | $22.91 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $22.91 / $26.92
| Professional | | $22.91 | $22.91 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $15.85 / $48.98
| Professional | | $15.85 | $15.85 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.45 / $22.39 / $100.00
| Facility | | $14.45 | $22.39 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $15.85 / $33.88
| Professional | | $7.76 | $15.85 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.12 / $15.85 / $26.30
| Facility | | $9.12 | $15.85 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $13.49 / $38.02
| Professional | | $5.25 | $13.49 | $38.02 |