- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.68 / $8.68 / $17.26
| Facility | | $8.68 | $8.68 | $17.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.80 / $15.31 / $30.33
| Professional | | $7.80 | $15.31 | $30.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.82 / $75.00 / $75.00
| Facility | | $8.82 | $75.00 | $75.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $29.20 / $70.29
| Professional | | $15.49 | $29.20 | $70.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.10 / $21.54 / $39.27
| Professional | | $13.10 | $21.54 | $39.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.08 / $12.08 / $12.08
| Facility | | $12.08 | $12.08 | $12.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.77 / $15.77 / $21.79
| Professional | | $15.77 | $15.77 | $21.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.73 / $16.10 / $21.47
| Facility | | $14.73 | $16.10 | $21.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.59 / $24.28 / $38.02
| Professional | | $16.59 | $24.28 | $38.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.11 / $25.62 / $48.26
| Professional | | $14.11 | $25.62 | $48.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.54 / $47.54 / $47.54
| Professional | | $47.54 | $47.54 | $47.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $75.00
| Facility | | $75.00 | $75.00 | $75.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.10 / $35.49 / $118.24
| Professional | | $20.10 | $35.49 | $118.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.57 / $22.58 / $31.38
| Facility | | $12.57 | $22.58 | $31.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.56 / $21.76 / $37.77
| Professional | | $10.56 | $21.76 | $37.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.92 / $28.18 / $54.43
| Professional | | $18.92 | $28.18 | $54.43 |