- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.55 / $18.30 / $36.21
| Facility | | $6.55 | $18.30 | $36.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.54 / $6.55 / $12.49
| Professional | | $3.54 | $6.55 | $12.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.66 / $12.70 / $100.00
| Facility | | $6.66 | $12.70 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.38 / $7.30 / $18.89
| Professional | | $4.38 | $7.30 | $18.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.61 / $20.48 / $35.79
| Facility | | $12.61 | $20.48 | $35.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.86 / $6.86 / $8.80
| Professional | | $6.86 | $6.86 | $8.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.09 / $10.85 / $24.93
| Facility | | $5.09 | $10.85 | $24.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.37 / $7.61 / $12.20
| Professional | | $4.37 | $7.61 | $12.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.15 / $3,472.00 / $9,239.00
| Facility | | $31.15 | $3,472.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.73 / $10.73 / $12.62
| Professional | | $10.73 | $10.73 | $12.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.30 / $10.11 / $26.33
| Professional | | $7.30 | $10.11 | $26.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.70 / $100.00 / $100.00
| Facility | | $12.70 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.50 / $4.90 / $18.89
| Professional | | $3.50 | $4.90 | $18.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.50 / $5.77 / $28.95
| Professional | | $3.50 | $5.77 | $28.95 |