- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.12 / $45.98 / $112.50
| Facility | | $11.12 | $45.98 | $112.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $10.11 / $10.91
| Professional | | $8.71 | $10.11 | $10.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.97 / $8.06 / $8.06
| Professional | | $6.97 | $8.06 | $8.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.19 / $26.70 / $100.00
| Facility | | $12.19 | $26.70 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.73 / $10.45 / $20.00
| Professional | | $5.73 | $10.45 | $20.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.02 / $23.78 / $44.12
| Facility | | $8.02 | $23.78 | $44.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.09 / $15.18 / $23.37
| Professional | | $8.09 | $15.18 | $23.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.26 / $11.20 / $12.32
| Professional | | $8.26 | $11.20 | $12.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.61 / $12.19 / $30.75
| Facility | | $11.61 | $12.19 | $30.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.61 / $17.42 / $31.93
| Facility | | $11.61 | $17.42 | $31.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.45 / $10.45 / $10.45
| Professional | | $10.45 | $10.45 | $10.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.35 / $19.16 / $31.93
| Facility | | $13.35 | $19.16 | $31.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $11.61 / $31.44
| Professional | | $8.71 | $11.61 | $31.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.88 / $4.88 / $11.61
| Professional | | $4.88 | $4.88 | $11.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.22 / $5.22 / $6.01
| Professional | | $5.22 | $5.22 | $6.01 |