- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.26 / $15.80 / $18.35
| Facility | | $11.26 | $15.80 | $18.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.63 / $15.80 / $19.38
| Professional | | $13.63 | $15.80 | $19.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.88 / $25.88 / $25.88
| Facility | | $25.88 | $25.88 | $25.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.88 / $25.88 / $25.88
| Professional | | $25.88 | $25.88 | $25.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.36 / $21.36 / $21.36
| Facility | | $21.36 | $21.36 | $21.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.77 / $15.77 / $15.77
| Professional | | $15.77 | $15.77 | $15.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.63 / $38.40 / $332.00
| Facility | | $19.63 | $38.40 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.63 / $28.07 / $41.62
| Professional | | $19.63 | $28.07 | $41.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.82 / $16.71 / $17.77
| Facility | | $14.82 | $16.71 | $17.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.63 / $19.55 / $31.62
| Professional | | $13.63 | $19.55 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.36 / $21.36 / $597.00
| Facility | | $21.36 | $21.36 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.77 / $15.86 / $44.18
| Professional | | $15.77 | $15.86 | $44.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.51 / $21.32 / $42.59
| Professional | | $14.51 | $21.32 | $42.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.71 / $19.57 / $19.57
| Facility | | $16.71 | $19.57 | $19.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.04 / $19.57 / $33.57
| Professional | | $16.04 | $19.57 | $33.57 |