- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.00 / $5.00 / $73.59
| Facility | | $5.00 | $5.00 | $73.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $5.00 / $90.63
| Professional | | $5.00 | $5.00 | $90.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.79 / $35.40 / $65.89
| Facility | | $14.79 | $35.40 | $65.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.83 / $9.83 / $9.83
| Professional | | $9.83 | $9.83 | $9.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.44 / $34.27 / $38.88
| Facility | | $12.44 | $34.27 | $38.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $9.50 / $14.87
| Professional | | $5.00 | $9.50 | $14.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.75 / $33.75 / $33.75
| Facility | | $33.75 | $33.75 | $33.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.69 / $12.39 / $15.79
| Professional | | $8.69 | $12.39 | $15.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.35 / $80.00 / $85.00
| Facility | | $20.35 | $80.00 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.67 / $11.83 / $16.80
| Professional | | $8.67 | $11.83 | $16.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.00 / $7.15 / $14.54
| Facility | | $5.00 | $7.15 | $14.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.26 / $9.50 / $13.61
| Professional | | $8.26 | $9.50 | $13.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.85 / $25.93 / $33.92
| Facility | | $18.85 | $25.93 | $33.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.00 / $7.15 / $18.57
| Facility | | $5.00 | $7.15 | $18.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.26 / $12.49 / $17.00
| Professional | | $8.26 | $12.49 | $17.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.65 / $13.16 / $18.36
| Professional | | $10.65 | $13.16 | $18.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.18 / $7.18 / $11.41
| Professional | | $7.18 | $7.18 | $11.41 |