- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.50 / $712.54 / $3,464.31
| Facility | | $6.50 | $712.54 | $3,464.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.50 / $657.00 / $2,469.09
| Professional | | $6.50 | $657.00 | $2,469.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.20 / $5.20 / $6.50
| Facility | | $5.20 | $5.20 | $6.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.39 / $6.50 / $10.34
| Professional | | $6.39 | $6.50 | $10.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.19 / $6.19 / $6.50
| Facility | | $6.19 | $6.19 | $6.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.19 / $6.19 / $6.19
| Professional | | $6.19 | $6.19 | $6.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.13 / $6.13 / $6.25
| Facility | | $6.13 | $6.13 | $6.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.25 / $6.25 / $6.25
| Professional | | $6.25 | $6.25 | $6.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.13 / $9.19 / $332.00
| Facility | | $6.13 | $9.19 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.50 / $6.50 / $8.40
| Professional | | $6.50 | $6.50 | $8.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.50 / $6.50 / $6.62
| Facility | | $6.50 | $6.50 | $6.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.50 / $6.50 / $6.62
| Professional | | $6.50 | $6.50 | $6.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.84 / $7.55 / $10.65
| Facility | | $4.84 | $7.55 | $10.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.13 / $6.13 / $555.00
| Facility | | $6.13 | $6.13 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.25 / $6.47 / $9.18
| Professional | | $6.25 | $6.47 | $9.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.50 / $6.50 / $8.38
| Professional | | $6.50 | $6.50 | $8.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.62 / $6.62 / $6.62
| Facility | | $6.62 | $6.62 | $6.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.78 / $6.50 / $6.62
| Professional | | $5.78 | $6.50 | $6.62 |