- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.10 / $18.10 / $18.10
| Facility | | $18.10 | $18.10 | $18.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.28 / $14.51 / $18.10
| Professional | | $13.28 | $14.51 | $18.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.91 / $80.00 / $80.00
| Facility | | $13.91 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.10 / $16.55 / $41.00
| Professional | | $6.10 | $16.55 | $41.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.61 / $59.81 / $71.11
| Facility | | $14.61 | $59.81 | $71.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.62 / $14.80 / $29.69
| Professional | | $11.62 | $14.80 | $29.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.98 / $13.60 / $18.36
| Professional | | $5.98 | $13.60 | $18.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.91 / $13.91 / $16.25
| Facility | | $13.91 | $13.91 | $16.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.34 / $13.91 / $13.91
| Professional | | $6.34 | $13.91 | $13.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.60 / $27.31 / $39.47
| Professional | | $13.60 | $27.31 | $39.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.64 / $111.28 / $166.92
| Professional | | $55.64 | $111.28 | $166.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.00 / $80.00 / $80.00
| Facility | | $70.00 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.39 / $12.12 / $41.00
| Professional | | $5.39 | $12.12 | $41.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.91 / $13.91 / $13.91
| Professional | | $13.91 | $13.91 | $13.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.13 / $8.23 / $18.39
| Professional | | $5.13 | $8.23 | $18.39 |