- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.61 / $20.79 / $54.00
| Facility | | $9.61 | $20.79 | $54.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.71 / $9.61 / $11.54
| Professional | | $5.71 | $9.61 | $11.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.44 / $10.34 / $11.84
| Facility | | $8.44 | $10.34 | $11.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.55 / $9.85 / $18.39
| Professional | | $6.55 | $9.85 | $18.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.68 / $16.68 / $16.68
| Facility | | $16.68 | $16.68 | $16.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.67 / $6.67 / $15.92
| Professional | | $6.67 | $6.67 | $15.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.55 / $6.55 / $6.55
| Facility | | $6.55 | $6.55 | $6.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.55 / $6.55 / $7.49
| Professional | | $6.55 | $6.55 | $7.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.26 / $638.07 / $801.00
| Professional | | $283.26 | $638.07 | $801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.21 / $100.00 / $100.00
| Facility | | $12.21 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.60 / $990.60 / $990.60
| Professional | | $990.60 | $990.60 | $990.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.95 / $14.24 / $60.00
| Professional | | $6.95 | $14.24 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.18 / $10.50 / $13.17
| Facility | | $6.18 | $10.50 | $13.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.55 / $6.55 / $11.59
| Professional | | $6.55 | $6.55 | $11.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.59 / $11.59 / $20.69
| Professional | | $11.59 | $11.59 | $20.69 |