- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.58 / $7.32 / $18.32
| Facility | | $5.58 | $7.32 | $18.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.84 / $7.05 / $17.60
| Professional | | $4.84 | $7.05 | $17.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.96 / $3.76 / $14.10
| Professional | | $2.96 | $3.76 | $14.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.10 / $7.63 / $7.63
| Facility | | $7.10 | $7.63 | $7.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.63 / $7.63 / $7.63
| Professional | | $7.63 | $7.63 | $7.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.67 / $10.67 / $10.67
| Facility | | $10.67 | $10.67 | $10.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.72 / $3.72 / $3.72
| Professional | | $3.72 | $3.72 | $3.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.10 / $16.64 / $332.00
| Facility | | $9.10 | $16.64 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.56 / $12.32 / $19.75
| Professional | | $9.56 | $12.32 | $19.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.14 / $14.14 / $14.14
| Facility | | $14.14 | $14.14 | $14.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.63 / $15.03 / $15.03
| Professional | | $7.63 | $15.03 | $15.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.67 / $10.67 / $597.00
| Facility | | $10.67 | $10.67 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.72 / $3.72 / $16.48
| Professional | | $3.72 | $3.72 | $16.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $5.46 / $11.46
| Professional | | $3.02 | $5.46 | $11.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.14 / $14.14 / $15.32
| Facility | | $14.14 | $14.14 | $15.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.14 / $14.14 / $15.03
| Professional | | $14.14 | $14.14 | $15.03 |