- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.75 / $12.88 / $22.91
| Facility | | $5.75 | $12.88 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $3.98 / $21.38
| Professional | | $3.02 | $3.98 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.37 / $6.76 / $100.00
| Facility | | $4.37 | $6.76 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.16 / $5.75 / $12.02
| Professional | | $3.16 | $5.75 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.12 / $11.48 / $18.20
| Facility | | $9.12 | $11.48 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $5.50 / $6.03
| Professional | | $5.50 | $5.50 | $6.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.07 / $7.94 / $18.20
| Facility | | $4.07 | $7.94 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $7.08 / $8.71
| Professional | | $3.63 | $7.08 | $8.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.25 / $3,630.78 / $9,772.37
| Facility | | $5.25 | $3,630.78 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $8.32 / $10.00
| Professional | | $8.32 | $8.32 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $5.75 / $14.45
| Professional | | $5.75 | $5.75 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $10.47 / $38.90
| Facility | | $10.47 | $10.47 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.37 / $6.76 / $100.00
| Facility | | $4.37 | $6.76 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.16 / $5.75 / $12.02
| Professional | | $3.16 | $5.75 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.88 / $5.75 / $7.94
| Facility | | $2.88 | $5.75 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.16 / $5.75 / $11.48
| Professional | | $3.16 | $5.75 | $11.48 |