- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.19 / $18.89 / $50.91
| Facility | | $11.19 | $18.89 | $50.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.18 / $11.30 / $14.00
| Professional | | $11.18 | $11.30 | $14.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.02 / $11.87 / $16.11
| Facility | | $9.02 | $11.87 | $16.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.44 / $11.19 / $22.28
| Professional | | $9.44 | $11.19 | $22.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.99 / $16.76 / $28.35
| Facility | | $14.99 | $16.76 | $28.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.36 / $16.36 / $40.90
| Professional | | $16.36 | $16.36 | $40.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.55 / $10.55 / $11.19
| Facility | | $10.55 | $10.55 | $11.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.19 / $11.19 / $11.19
| Professional | | $11.19 | $11.19 | $11.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.07 / $13.43 / $25.36
| Professional | | $10.07 | $13.43 | $25.36 |
- 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
- $10.55 / $11.19 / $16.00
| Facility | | $10.55 | $11.19 | $16.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.19 / $11.19 / $24.20
| Professional | | $11.19 | $11.19 | $24.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.41 / $9.41 / $9.41
| Professional | | $9.41 | $9.41 | $9.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.94 / $12.30 / $19.02
| Professional | | $8.94 | $12.30 | $19.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.19 / $11.19 / $28.27
| Professional | | $11.19 | $11.19 | $28.27 |