- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.56 / $6.41 / $273.00
| Facility | | $2.56 | $6.41 | $273.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.13 / $2.56 / $4.63
| Professional | | $2.13 | $2.56 | $4.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.83 / $2.85 / $5.11
| Facility | | $1.83 | $2.85 | $5.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.57 / $2.79 / $6.66
| Professional | | $2.57 | $2.79 | $6.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.62 / $2.79 / $4.62
| Facility | | $2.62 | $2.79 | $4.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.56 / $2.56 / $7.28
| Professional | | $2.56 | $2.56 | $7.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.62 / $2.62 / $2.62
| Facility | | $2.62 | $2.62 | $2.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.62 / $2.62 / $2.62
| Professional | | $2.62 | $2.62 | $2.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $8.00 / $393.93
| Professional | | $5.00 | $8.00 | $393.93 |
- 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
- $2.62 / $2.62 / $3.67
| Facility | | $2.62 | $2.62 | $3.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.62 / $2.78 / $6.12
| Professional | | $2.62 | $2.78 | $6.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.57 / $2.57 / $6.34
| Professional | | $2.57 | $2.57 | $6.34 |