- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.24 / $41.78 / $125.44
| Facility | | $15.24 | $41.78 | $125.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.06 / $11.24 / $18.82
| Professional | | $10.06 | $11.24 | $18.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.50 / $23.86 / $109.00
| Facility | | $12.50 | $23.86 | $109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.58 / $13.71 / $32.77
| Professional | | $6.58 | $13.71 | $32.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.35 / $38.50 / $67.30
| Facility | | $19.35 | $38.50 | $67.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.89 / $12.89 / $13.57
| Professional | | $12.89 | $12.89 | $13.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.58 / $20.39 / $46.84
| Facility | | $9.58 | $20.39 | $46.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.33 / $12.86 / $23.05
| Professional | | $8.33 | $12.86 | $23.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.89 / $3,472.00 / $9,239.00
| Facility | | $37.89 | $3,472.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.60 / $19.60 / $23.06
| Professional | | $19.60 | $19.60 | $23.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.71 / $19.00 / $48.89
| Professional | | $13.71 | $19.00 | $48.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.76 / $13.76 / $13.76
| Facility | | $13.76 | $13.76 | $13.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.86 / $109.00 / $109.00
| Facility | | $23.86 | $109.00 | $109.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $8.23 / $23.00
| Professional | | $5.25 | $8.23 | $23.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $8.85 / $25.17
| Professional | | $5.25 | $8.85 | $25.17 |