- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.14 / $20.26 / $22.74
| Facility | | $10.14 | $20.26 | $22.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.14 / $10.24 / $3,138.66
| Professional | | $10.14 | $10.24 | $3,138.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.40 / $16.20 / $36.31
| Facility | | $10.40 | $16.20 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.13 / $10.14 / $22.27
| Professional | | $10.13 | $10.14 | $22.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.31 / $11.86 / $20.92
| Facility | | $11.31 | $11.86 | $20.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.33 / $10.33 / $27.89
| Professional | | $10.33 | $10.33 | $27.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.57 / $9.57 / $10.14
| Facility | | $9.57 | $9.57 | $10.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.14 / $10.14 / $10.14
| Professional | | $10.14 | $10.14 | $10.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.13 / $12.17 / $23.32
| Professional | | $9.13 | $12.17 | $23.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $100.00
| Facility | | $75.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.57 / $10.14 / $14.23
| Facility | | $9.57 | $10.14 | $14.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.14 / $10.14 / $21.93
| Professional | | $10.14 | $10.14 | $21.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.54 / $14.54 / $14.54
| Professional | | $14.54 | $14.54 | $14.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.11 / $11.15 / $17.23
| Professional | | $8.11 | $11.15 | $17.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.14 / $10.14 / $20.90
| Professional | | $10.14 | $10.14 | $20.90 |