- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.97 / $10.25 / $13.94
| Facility | | $6.97 | $10.25 | $13.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.43 / $10.25 / $10.66
| Professional | | $8.43 | $10.25 | $10.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.15 / $10.25 / $13.01
| Professional | | $7.15 | $10.25 | $13.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.35 / $7.35 / $7.72
| Facility | | $7.35 | $7.35 | $7.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.35 / $7.35 / $7.35
| Professional | | $7.35 | $7.35 | $7.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.00 / $9.67 / $9.67
| Facility | | $8.00 | $9.67 | $9.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.25 / $10.25 / $10.25
| Professional | | $10.25 | $10.25 | $10.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.67 / $14.51 / $332.00
| Facility | | $9.67 | $14.51 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.12 / $11.12 / $15.00
| Professional | | $11.12 | $11.12 | $15.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.25 / $10.25 / $10.63
| Facility | | $10.25 | $10.25 | $10.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.25 / $10.25 / $10.63
| Professional | | $10.25 | $10.25 | $10.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.00 / $9.67 / $555.00
| Facility | | $8.00 | $9.67 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.79 / $10.25 / $14.00
| Professional | | $7.79 | $10.25 | $14.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.25 / $10.25 / $18.62
| Professional | | $10.25 | $10.25 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.63 / $10.63 / $10.63
| Facility | | $10.63 | $10.63 | $10.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.96 / $10.25 / $12.43
| Professional | | $9.96 | $10.25 | $12.43 |