- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.44 / $5.44 / $5.44
| Facility | | $5.44 | $5.44 | $5.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.48 / $6.94 / $51.62
| Professional | | $4.48 | $6.94 | $51.62 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $5.44 / $18.07 / $34.71
| Professional | 25 | $5.44 | $18.07 | $34.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.96 / $8.96 / $70.00
| Facility | | $8.96 | $8.96 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.05 / $10.44 / $29.81
| Professional | | $5.05 | $10.44 | $29.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.56 / $65.31 / $68.43
| Facility | | $57.56 | $65.31 | $68.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.86 / $7.99 / $12.97
| Professional | | $4.86 | $7.99 | $12.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.10 / $5.00 / $16.00
| Professional | | $3.10 | $5.00 | $16.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.07 / $6.07 / $6.14
| Facility | | $6.07 | $6.07 | $6.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.94 / $5.42 / $9.36
| Professional | | $2.94 | $5.42 | $9.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.87 / $9.77 / $14.27
| Professional | | $4.87 | $9.77 | $14.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.23 / $6.23 / $34.45
| Facility | | $6.23 | $6.23 | $34.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.92 / $9.36 / $16.44
| Professional | | $5.92 | $9.36 | $16.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.96 / $8.96 / $70.00
| Facility | | $8.96 | $8.96 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.45 / $12.26 / $29.81
| Professional | | $5.45 | $12.26 | $29.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.87 / $10.27 / $49.87
| Facility | | $3.87 | $10.27 | $49.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.63 / $7.29 / $11.81
| Professional | | $4.63 | $7.29 | $11.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.20 / $8.01 / $19.88
| Professional | | $5.20 | $8.01 | $19.88 |