- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.65 / $39.38 / $116.17
| Facility | | $15.65 | $39.38 | $116.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.05 / $15.65 / $20.37
| Professional | | $14.05 | $15.65 | $20.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.69 / $32.11 / $64.08
| Facility | | $12.69 | $32.11 | $64.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.98 / $14.98 / $14.98
| Professional | | $14.98 | $14.98 | $14.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.36 / $35.36 / $35.36
| Facility | | $35.36 | $35.36 | $35.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.75 / $14.75 / $14.75
| Facility | | $14.75 | $14.75 | $14.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.75 / $14.75 / $14.75
| Professional | | $14.75 | $14.75 | $14.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.99 / $100.00 / $100.00
| Facility | | $32.99 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.65 / $22.38 / $30.77
| Facility | | $15.65 | $22.38 | $30.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.79 / $20.79 / $20.79
| Professional | | $20.79 | $20.79 | $20.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.75 / $14.75 / $28.03
| Facility | | $14.75 | $14.75 | $28.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.75 / $14.75 / $20.79
| Professional | | $14.75 | $14.75 | $20.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.83 / $13.83 / $13.83
| Facility | | $13.83 | $13.83 | $13.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.63 / $15.68 / $15.79
| Professional | | $12.63 | $15.68 | $15.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.29 / $12.29 / $16.59
| Professional | | $12.29 | $12.29 | $16.59 |