- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.51 / $5.51 / $5.51
| Facility | | $5.51 | $5.51 | $5.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.51 / $5.45 / $5.51
| Professional | | $4.51 | $5.45 | $5.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.86 / $20.07 / $45.36
| Facility | | $5.86 | $20.07 | $45.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.69 / $5.86 / $5.86
| Professional | | $4.69 | $5.86 | $5.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.87 / $21.50 / $51.72
| Facility | | $11.87 | $21.50 | $51.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.67 / $8.39 / $11.32
| Professional | | $6.67 | $8.39 | $11.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.75 / $19.66 / $40.72
| Facility | | $11.75 | $19.66 | $40.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.61 / $6.61 / $10.44
| Professional | | $6.61 | $6.61 | $10.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.86 / $11.72 / $100.00
| Facility | | $5.86 | $11.72 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.46 / $4.32 / $12.43
| Professional | | $2.46 | $4.32 | $12.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.46 / $4.82 / $12.48
| Professional | | $2.46 | $4.82 | $12.48 |