- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.37 / $7.17 / $38.09
| Professional | | $5.37 | $7.17 | $38.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.65 / $16.05 / $23.40
| Facility | | $13.65 | $16.05 | $23.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.28 / $7.78 / $24.94
| Professional | | $5.28 | $7.78 | $24.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.71 / $5.30 / $19.48
| Professional | | $3.71 | $5.30 | $19.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.76 / $34.76 / $34.76
| Facility | | $34.76 | $34.76 | $34.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.45 / $9.77 / $33.70
| Professional | | $4.45 | $9.77 | $33.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.52 / $14.65 / $19.78
| Professional | | $6.52 | $14.65 | $19.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.19 / $16.12 / $25.64
| Professional | | $13.19 | $16.12 | $25.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.89 / $69.59 / $100.00
| Facility | | $35.89 | $69.59 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $109.88
| Professional | | $100.00 | $100.00 | $109.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.03 / $17.57 / $38.10
| Facility | | $10.03 | $17.57 | $38.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.58 / $16.12 / $27.83
| Professional | | $4.58 | $16.12 | $27.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.42 / $51.42 / $51.42
| Professional | | $51.42 | $51.42 | $51.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.72 / $11.72 / $97.80
| Professional | | $11.72 | $11.72 | $97.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.50 / $31.50 / $31.50
| Facility | | $31.50 | $31.50 | $31.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $8.78 / $32.47
| Professional | | $5.00 | $8.78 | $32.47 |