- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.25 / $30.54 / $71.68
| Facility | | $13.25 | $30.54 | $71.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.26 / $12.21 / $24.06
| Professional | | $10.26 | $12.21 | $24.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.95 / $7.95 / $7.95
| Professional | | $7.95 | $7.95 | $7.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.91 / $26.50 / $70.00
| Facility | | $13.91 | $26.50 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.54 / $12.06 / $23.82
| Professional | | $6.54 | $12.06 | $23.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.18 / $27.12 / $39.67
| Facility | | $9.18 | $27.12 | $39.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.30 / $17.42 / $26.30
| Professional | | $9.30 | $17.42 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.43 / $12.78 / $14.05
| Professional | | $9.43 | $12.78 | $14.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.25 / $14.58 / $29.25
| Facility | | $13.25 | $14.58 | $29.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.25 / $19.88 / $36.44
| Facility | | $13.25 | $19.88 | $36.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.93 / $11.93 / $11.93
| Professional | | $11.93 | $11.93 | $11.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.24 / $21.86 / $36.44
| Facility | | $15.24 | $21.86 | $36.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.94 / $13.25 / $35.93
| Professional | | $9.94 | $13.25 | $35.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.57 / $5.57 / $15.90
| Professional | | $5.57 | $5.57 | $15.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.96 / $5.96 / $6.86
| Professional | | $5.96 | $5.96 | $6.86 |