- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.32 / $5.32 / $16.36
| Facility | | $5.32 | $5.32 | $16.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.12 / $20.12 / $47.88
| Professional | | $14.12 | $20.12 | $47.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.22 / $19.09 / $34.77
| Professional | | $17.22 | $19.09 | $34.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.86 / $17.05 / $30.92
| Facility | | $15.86 | $17.05 | $30.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.52 / $17.23 / $29.63
| Professional | | $13.52 | $17.23 | $29.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $20.49 / $50.00
| Professional | | $17.05 | $20.49 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.94 / $22.13 / $46.51
| Professional | | $15.94 | $22.13 | $46.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.42 / $90.49 / $90.49
| Facility | | $84.42 | $90.49 | $90.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.95 / $381.28 / $392.72
| Professional | | $27.95 | $381.28 | $392.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.43 / $22.24 / $73.06
| Facility | | $14.43 | $22.24 | $73.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.64 / $23.97 / $41.66
| Professional | | $19.64 | $23.97 | $41.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.61 / $18.23 / $23.14
| Professional | | $16.61 | $18.23 | $23.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.19 / $21.97 / $71.80
| Facility | | $14.19 | $21.97 | $71.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.30 / $23.25 / $42.92
| Professional | | $16.30 | $23.25 | $42.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $20.57 / $46.33
| Professional | | $15.14 | $20.57 | $46.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.50 / $18.09 / $62.00
| Professional | | $15.50 | $18.09 | $62.00 |