- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.03 / $0.03 / $215.48
| Facility | | $0.03 | $0.03 | $215.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $0.03 / $0.03
| Professional | | $0.03 | $0.03 | $0.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.33 / $5.33 / $12.06
| Professional | | $5.33 | $5.33 | $12.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.18 / $59.55 / $69.55
| Facility | | $1.18 | $59.55 | $69.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.30 / $28.92 / $46.46
| Professional | | $0.30 | $28.92 | $46.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.24 / $34.85 / $35.67
| Professional | | $34.24 | $34.85 | $35.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.98 / $15.98 / $28.57
| Facility | | $15.98 | $15.98 | $28.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.10 / $22.72 / $22.72
| Professional | | $15.10 | $22.72 | $22.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.21 / $28.45 / $4,071.00
| Facility | | $12.21 | $28.45 | $4,071.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.21 / $28.45 / $4,071.00
| Professional | | $12.21 | $28.45 | $4,071.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.06 / $13.53 / $23.96
| Professional | | $10.06 | $13.53 | $23.96 |