- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.13 / $19.50 / $40.74
| Facility | | $14.13 | $19.50 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $18.62 / $60.26
| Professional | | $13.18 | $18.62 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $36.31 / $100.00
| Facility | | $12.30 | $36.31 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $13.49 / $16.60
| Professional | | $12.30 | $13.49 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.49 / $15.49 / $30.90
| Facility | | $15.49 | $15.49 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.79 / $14.79 / $14.79
| Facility | | $14.79 | $14.79 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.79 / $14.79 / $14.79
| Professional | | $14.79 | $14.79 | $14.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $18.62 / $37.15
| Professional | | $15.85 | $18.62 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $13.80 / $25.12
| Professional | | $11.75 | $13.80 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.18 / $95.50 / $97.72
| Facility | | $13.18 | $95.50 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $36.31 / $100.00
| Facility | | $12.30 | $36.31 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $12.88 / $16.60
| Professional | | $12.30 | $12.88 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.85 / $26.30 / $33.88
| Facility | | $15.85 | $26.30 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.10 / $15.85 / $20.89
| Professional | | $0.10 | $15.85 | $20.89 |