- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.18 / $63.10 / $213.80
| Facility | | $28.18 | $63.10 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $19.05 / $138.04
| Professional | | $14.13 | $19.05 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.05 / $29.51 / $100.00
| Facility | | $19.05 | $29.51 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $20.89 / $43.65
| Professional | | $12.59 | $20.89 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.74 / $51.29 / $81.28
| Facility | | $40.74 | $51.29 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $19.50 / $26.92
| Professional | | $19.50 | $19.50 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.22 / $33.11 / $81.28
| Facility | | $16.22 | $33.11 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $25.12 / $35.48
| Professional | | $15.14 | $25.12 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $3,630.78 / $9,772.37
| Facility | | $30.20 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $35.48
| Professional | | $30.20 | $30.20 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $20.89 / $63.10
| Professional | | $20.89 | $20.89 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.55 / $45.71 / $128.82
| Facility | | $24.55 | $45.71 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.05 / $29.51 / $100.00
| Facility | | $19.05 | $29.51 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $20.89 / $43.65
| Professional | | $12.59 | $20.89 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $20.89 / $33.88
| Facility | | $12.02 | $20.89 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $17.38 / $50.12
| Professional | | $10.23 | $17.38 | $50.12 |