- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.14 / $15.14 / $15.14
| Facility | | $15.14 | $15.14 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $16.98 / $48.98
| Professional | | $14.13 | $16.98 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.95 / $23.44 / $100.00
| Facility | | $19.95 | $23.44 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $21.38 / $40.74
| Professional | | $16.60 | $21.38 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $20.89 / $40.74
| Professional | | $14.45 | $20.89 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $19.95 / $39.81
| Professional | | $15.49 | $19.95 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $18.62 / $26.30
| Professional | | $12.59 | $18.62 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $20.42 / $51.29
| Professional | | $16.60 | $20.42 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $107.15 / $107.15
| Facility | | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $134.90 / $134.90
| Professional | | $123.03 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.99 / $23.99 / $23.99
| Professional | | $23.99 | $23.99 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.85 / $21.88 / $33.88
| Facility | | $15.85 | $21.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $20.42 / $42.66
| Professional | | $15.49 | $20.42 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $48.98 / $48.98
| Professional | | $48.98 | $48.98 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $18.62 / $23.44
| Professional | | $12.59 | $18.62 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $16.22 / $32.36
| Professional | | $12.02 | $16.22 | $32.36 |