- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.38 / $5.38 / $351.00
| Facility | | $5.38 | $5.38 | $351.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.83 / $5.38 / $66.30
| Professional | | $3.83 | $5.38 | $66.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.10 / $11.10 / $11.10
| Facility | | $11.10 | $11.10 | $11.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.61 / $10.44 / $13.06
| Professional | | $6.61 | $10.44 | $13.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.48 / $9.17 / $60.00
| Facility | | $5.48 | $9.17 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.43 / $5.15 / $11.78
| Professional | | $3.43 | $5.15 | $11.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.37 / $11.66 / $17.93
| Facility | | $7.37 | $11.66 | $17.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.37 / $12.72 / $16.39
| Professional | | $7.37 | $12.72 | $16.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.35 / $13.78 / $15.71
| Professional | | $9.35 | $13.78 | $15.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.40 / $4.00 / $6.86
| Professional | | $2.40 | $4.00 | $6.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.72 / $5.72 / $5.72
| Professional | | $5.72 | $5.72 | $5.72 |