- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.70 / $6.13 / $11.30
| Facility | | $4.70 | $6.13 | $11.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.63 / $6.13 / $10.21
| Professional | | $4.63 | $6.13 | $10.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.63 / $4.63 / $17.30
| Professional | | $4.63 | $4.63 | $17.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.36 / $8.99 / $8.99
| Facility | | $8.36 | $8.99 | $8.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.99 / $8.99 / $8.99
| Professional | | $8.99 | $8.99 | $8.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.31 / $12.31 / $12.31
| Facility | | $12.31 | $12.31 | $12.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.51 / $5.51 / $5.51
| Professional | | $5.51 | $5.51 | $5.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.79 / $19.75 / $332.00
| Facility | | $10.79 | $19.75 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.79 / $14.57 / $23.41
| Professional | | $10.79 | $14.57 | $23.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.15 / $2.15 / $6.24
| Facility | | $2.15 | $2.15 | $6.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.15 / $6.24 / $6.63
| Professional | | $2.15 | $6.24 | $6.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.31 / $12.31 / $597.00
| Facility | | $12.31 | $12.31 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.51 / $5.51 / $18.48
| Professional | | $5.51 | $5.51 | $18.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.59 / $6.47 / $11.91
| Professional | | $3.59 | $6.47 | $11.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.24 / $6.24 / $7.72
| Facility | | $6.24 | $6.24 | $7.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.15 / $6.24 / $6.63
| Professional | | $2.15 | $6.24 | $6.63 |