- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $33.88
| Facility | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $19.05 / $19.05
| Professional | | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $5.01 / $14.45
| Professional | | $5.01 | $5.01 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.89 / $46.77 / $69.18
| Facility | | $3.89 | $46.77 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $20.42 / $45.71
| Professional | | $10.96 | $20.42 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $33.88 / $35.48
| Professional | | $23.44 | $33.88 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.01 / $5.01 / $28.84
| Facility | | $5.01 | $5.01 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $5.01 / $12.88
| Professional | | $5.01 | $5.01 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $28.18 / $10,000.00
| Facility | | $12.02 | $28.18 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $28.18 / $10,000.00
| Professional | | $11.75 | $28.18 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.32 / $12.02 / $15.49
| Facility | | $8.32 | $12.02 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $12.30 / $21.38
| Professional | | $10.00 | $12.30 | $21.38 |