- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.24 / $30.51 / $94.53
| Facility | | $13.24 | $30.51 | $94.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.25 / $22.50 / $24.00
| Professional | | $11.25 | $22.50 | $24.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.19 / $9.19 / $9.19
| Professional | | $9.19 | $9.19 | $9.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.90 / $25.82 / $83.15
| Facility | | $13.90 | $25.82 | $83.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.54 / $12.45 / $23.86
| Professional | | $6.54 | $12.45 | $23.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.18 / $21.35 / $38.75
| Facility | | $9.18 | $21.35 | $38.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.11 / $17.20 / $26.30
| Professional | | $9.11 | $17.20 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.42 / $12.77 / $14.04
| Professional | | $9.42 | $12.77 | $14.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.24 / $13.90 / $29.23
| Facility | | $13.24 | $13.90 | $29.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.24 / $19.86 / $36.40
| Facility | | $13.24 | $19.86 | $36.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.92 / $11.92 / $11.92
| Professional | | $11.92 | $11.92 | $11.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.23 / $21.85 / $36.40
| Facility | | $15.23 | $21.85 | $36.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.93 / $13.24 / $35.93
| Professional | | $9.93 | $13.24 | $35.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.56 / $5.56 / $14.83
| Professional | | $5.56 | $5.56 | $14.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.96 / $5.96 / $6.86
| Professional | | $5.96 | $5.96 | $6.86 |