- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.28 / $78.41 / $154.56
| Facility | | $5.28 | $78.41 | $154.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.06 / $0.10 / $5.40
| Professional | | $0.06 | $0.10 | $5.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.05 / $0.05 / $0.42
| Professional | | $0.05 | $0.05 | $0.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.06 / $0.06 / $0.06
| Facility | | $0.06 | $0.06 | $0.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.06 / $0.06 / $0.13
| Professional | | $0.06 | $0.06 | $0.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.07 / $0.10 / $0.14
| Facility | | $0.07 | $0.10 | $0.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.13 / $0.13 / $0.13
| Professional | | $0.13 | $0.13 | $0.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,610.00 / $15,610.00 / $23,489.00
| Facility | | $15,610.00 | $15,610.00 | $23,489.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.06 / $0.06 / $0.08
| Professional | | $0.06 | $0.06 | $0.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $85.00 / $100.00
| Facility | | $75.00 | $85.00 | $100.00 |