- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.54 / $47.40 / $731.25
| Facility | | $2.54 | $47.40 | $731.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $2.64 / $54.29
| Professional | | $2.02 | $2.64 | $54.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.96 / $2.33 / $2.91
| Facility | | $1.96 | $2.33 | $2.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $2.18 / $8.73
| Professional | | $2.02 | $2.18 | $8.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.15 / $4.45 / $9.82
| Facility | | $4.15 | $4.45 | $9.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.19 / $2.19 / $6.21
| Professional | | $2.19 | $2.19 | $6.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.91 / $1.91 / $2.02
| Facility | | $1.91 | $1.91 | $2.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $2.02 / $2.02
| Professional | | $2.02 | $2.02 | $2.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.82 / $2.42 / $5.15
| Professional | | $1.82 | $2.42 | $5.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $100.00
| Facility | | $75.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.91 / $2.02 / $2.92
| Facility | | $1.91 | $2.02 | $2.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $2.02 / $4.37
| Professional | | $2.02 | $2.02 | $4.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.71 / $3.71 / $3.71
| Professional | | $3.71 | $3.71 | $3.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.62 / $2.23 / $3.44
| Professional | | $1.62 | $2.23 | $3.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $2.02 / $4.33
| Professional | | $2.02 | $2.02 | $4.33 |