- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.17 / $6.47 / $9.61
| Facility | | $5.17 | $6.47 | $9.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.53 / $5.17 / $16.89
| Professional | | $3.53 | $5.17 | $16.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.27 / $11.21 / $11.85
| Facility | | $9.27 | $11.21 | $11.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.13 / $2.13 / $17.82
| Professional | | $2.13 | $2.13 | $17.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.87 / $11.71 / $12.17
| Facility | | $2.87 | $11.71 | $12.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.71 / $13.69 / $21.00
| Facility | | $11.71 | $13.69 | $21.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.96 / $11.61 / $13.19
| Professional | | $4.96 | $11.61 | $13.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.83 / $3.83 / $5.17
| Facility | | $3.83 | $3.83 | $5.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.53 / $3.88 / $100.00
| Facility | | $3.53 | $3.88 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.52 / $4.30 / $11.94
| Professional | | $2.52 | $4.30 | $11.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.16 / $8.42 / $85.00
| Professional | | $2.16 | $8.42 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.83 / $3.83 / $5.17
| Facility | | $3.83 | $3.83 | $5.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.27 / $10.30 / $41.75
| Professional | | $5.27 | $10.30 | $41.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.61 / $8.61 / $100.00
| Facility | | $8.61 | $8.61 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $2.78 / $4.18
| Professional | | $2.27 | $2.78 | $4.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.18 / $9.18 / $16.82
| Professional | | $9.18 | $9.18 | $16.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.82 / $20.43 / $23.53
| Professional | | $16.82 | $20.43 | $23.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.16 / $3.61 / $11.81
| Professional | | $2.16 | $3.61 | $11.81 |