- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.76 / $11.16 / $13.39
| Professional | | $5.76 | $11.16 | $13.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.90 / $33.47 / $37.20
| Facility | | $27.90 | $33.47 | $37.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.28 / $7.94 / $29.70
| Professional | | $6.28 | $7.94 | $29.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.42 / $15.50 / $15.50
| Facility | | $14.42 | $15.50 | $15.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.50 / $15.50 / $15.50
| Professional | | $15.50 | $15.50 | $15.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.22 / $20.22 / $20.22
| Facility | | $20.22 | $20.22 | $20.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.70 / $6.70 / $6.70
| Professional | | $6.70 | $6.70 | $6.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.53 / $25.11 / $40.36
| Professional | | $19.53 | $25.11 | $40.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.65 / $10.65 / $10.65
| Facility | | $10.65 | $10.65 | $10.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.01 / $10.65 / $10.65
| Professional | | $1.01 | $10.65 | $10.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.22 / $555.00 / $597.00
| Facility | | $20.22 | $555.00 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.70 / $6.70 / $32.19
| Professional | | $6.70 | $6.70 | $32.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.19 / $9.27 / $16.03
| Professional | | $6.19 | $9.27 | $16.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.65 / $11.62 / $18.60
| Professional | | $10.65 | $11.62 | $18.60 |