- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.87 / $6.87 / $6.87
| Facility | | $6.87 | $6.87 | $6.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.36 / $7.23 / $51.00
| Professional | | $5.36 | $7.23 | $51.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.88 / $22.98 / $48.44
| Professional | | $11.88 | $22.98 | $48.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.54 / $36.86 / $48.98
| Facility | | $31.54 | $36.86 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.45 / $16.41 / $24.16
| Professional | | $7.45 | $16.41 | $24.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.87 / $10.11 / $26.00
| Facility | | $6.87 | $10.11 | $26.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.35 / $9.35 / $9.35
| Professional | | $9.35 | $9.35 | $9.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.62 / $10.11 / $68.47
| Facility | | $6.62 | $10.11 | $68.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.86 / $8.93 / $90.10
| Professional | | $6.86 | $8.93 | $90.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.49 / $58.40 / $85.00
| Professional | | $41.49 | $58.40 | $85.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.87 / $10.11 / $26.00
| Facility | | $6.87 | $10.11 | $26.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.35 / $9.35 / $9.35
| Professional | | $9.35 | $9.35 | $9.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.95 / $27.00 / $35.85
| Professional | | $12.95 | $27.00 | $35.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.98 / $22.48 / $90.00
| Facility | | $21.98 | $22.48 | $90.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.45 / $59.95 / $90.10
| Professional | | $7.45 | $59.95 | $90.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.32 / $7.24 / $13.33
| Professional | | $6.32 | $7.24 | $13.33 |