- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.67 / $13.67 / $101.50
| Facility | | $13.67 | $13.67 | $101.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.19 / $17.07 / $53.49
| Professional | | $9.19 | $17.07 | $53.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.22 / $27.87 / $34.14
| Professional | | $21.22 | $27.87 | $34.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.71 / $33.71 / $33.71
| Facility | | $33.71 | $33.71 | $33.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.25 / $12.25 / $33.38
| Professional | | $12.25 | $12.25 | $33.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.64 / $27.87 / $52.95
| Professional | | $25.64 | $27.87 | $52.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.67 / $21.70 / $113.26
| Facility | | $13.67 | $21.70 | $113.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.19 / $17.09 / $53.49
| Professional | | $9.19 | $17.09 | $53.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.90 / $11.70 / $54.90
| Professional | | $8.90 | $11.70 | $54.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.71 / $33.71 / $33.71
| Facility | | $33.71 | $33.71 | $33.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.25 / $12.25 / $33.38
| Professional | | $12.25 | $12.25 | $33.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.93 / $26.53 / $26.53
| Facility | | $19.93 | $26.53 | $26.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.93 / $26.53 / $27.26
| Professional | | $19.93 | $26.53 | $27.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $13.91 / $25.14
| Professional | | $10.54 | $13.91 | $25.14 |