- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.75 / $12.31 / $21.03
| Facility | | $8.75 | $12.31 | $21.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.75 / $12.31 / $19.00
| Professional | | $8.75 | $12.31 | $19.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.90 / $14.91 / $30.18
| Professional | | $8.90 | $14.91 | $30.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.57 / $16.73 / $16.73
| Facility | | $15.57 | $16.73 | $16.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.73 / $16.73 / $16.73
| Professional | | $16.73 | $16.73 | $16.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.54 / $23.54 / $23.54
| Facility | | $23.54 | $23.54 | $23.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.26 / $10.26 / $10.26
| Professional | | $10.26 | $10.26 | $10.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.09 / $36.76 / $332.00
| Facility | | $20.09 | $36.76 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.07 / $27.12 / $43.60
| Professional | | $18.07 | $27.12 | $43.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.62 / $11.62 / $11.62
| Facility | | $11.62 | $11.62 | $11.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.62 / $12.34 / $16.73
| Professional | | $11.62 | $12.34 | $16.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.54 / $23.54 / $597.00
| Facility | | $23.54 | $23.54 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.26 / $10.26 / $34.42
| Professional | | $10.26 | $10.26 | $34.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.68 / $11.36 / $21.72
| Professional | | $6.68 | $11.36 | $21.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.62 / $11.62 / $14.38
| Facility | | $11.62 | $11.62 | $14.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.62 / $11.62 / $12.34
| Professional | | $11.62 | $11.62 | $12.34 |