- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.11 / $21.11 / $39.26
| Facility | | $21.11 | $21.11 | $39.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.10 / $30.41 / $80.80
| Professional | | $21.10 | $30.41 | $80.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.28 / $51.35 / $102.46
| Facility | | $22.28 | $51.35 | $102.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.99 / $34.27 / $250.96
| Professional | | $20.99 | $34.27 | $250.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.48 / $17.96 / $20.36
| Professional | | $15.48 | $17.96 | $20.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.94 / $23.94 / $27.41
| Facility | | $23.94 | $23.94 | $27.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.16 / $38.58 / $73.83
| Professional | | $23.16 | $38.58 | $73.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.96 / $43.30 / $8,090.00
| Facility | | $20.96 | $43.30 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.23 / $22.71 / $37.21
| Professional | | $12.23 | $22.71 | $37.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.75 / $45.86 / $66.42
| Professional | | $23.75 | $45.86 | $66.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.78 / $35.97 / $65.79
| Professional | | $26.78 | $35.97 | $65.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.44 / $102.46 / $102.46
| Facility | | $49.44 | $102.46 | $102.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.83 / $38.54 / $250.96
| Professional | | $24.83 | $38.54 | $250.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $24.08 / $65.28
| Professional | | $17.05 | $24.08 | $65.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.16 / $30.99 / $63.26
| Professional | | $24.16 | $30.99 | $63.26 |