- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.35 / $5.35 / $5.35
| Facility | | $5.35 | $5.35 | $5.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.45 / $5.35 / $8.90
| Professional | | $3.45 | $5.35 | $8.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.64 / $25.96 / $80.00
| Facility | | $8.64 | $25.96 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.78 / $8.23 / $11.95
| Professional | | $4.78 | $8.23 | $11.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.72 / $8.69 / $8.69
| Professional | | $7.72 | $8.69 | $8.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.35 / $7.35 / $9.64
| Facility | | $7.35 | $7.35 | $9.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.25 / $7.35 / $14.25
| Professional | | $6.25 | $7.35 | $14.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.98 / $9.98 / $10.48
| Professional | | $9.98 | $9.98 | $10.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.60 / $136.60 / $136.60
| Facility | | $136.60 | $136.60 | $136.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.83 / $6.83 / $6.83
| Professional | | $6.83 | $6.83 | $6.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.85 / $80.00 / $80.00
| Facility | | $24.85 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.30 / $6.11 / $11.95
| Professional | | $4.30 | $6.11 | $11.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.82 / $7.82 / $8.23
| Professional | | $7.82 | $7.82 | $8.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.40 / $5.58 / $5.82
| Facility | | $3.40 | $5.58 | $5.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.40 / $6.11 / $12.24
| Professional | | $4.40 | $6.11 | $12.24 |