- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.98 / $21.88 / $27.59
| Facility | | $10.98 | $21.88 | $27.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.98 / $11.09 / $27.59
| Professional | | $10.98 | $11.09 | $27.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.26 / $17.54 / $39.31
| Facility | | $11.26 | $17.54 | $39.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.94 / $10.98 / $24.05
| Professional | | $10.94 | $10.98 | $24.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.70 / $11.76 / $24.15
| Facility | | $10.70 | $11.76 | $24.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.19 / $11.19 / $31.48
| Professional | | $11.19 | $11.19 | $31.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.36 / $10.36 / $10.98
| Facility | | $10.36 | $10.36 | $10.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.98 / $10.98 / $10.98
| Professional | | $10.98 | $10.98 | $10.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.88 / $13.18 / $24.88
| Professional | | $9.88 | $13.18 | $24.88 |
- 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
- $10.36 / $10.98 / $15.61
| Facility | | $10.36 | $10.98 | $15.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.98 / $10.98 / $23.75
| Professional | | $10.98 | $10.98 | $23.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.73 / $18.73 / $18.73
| Professional | | $18.73 | $18.73 | $18.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.77 / $12.08 / $18.66
| Professional | | $8.77 | $12.08 | $18.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.98 / $10.98 / $23.39
| Professional | | $10.98 | $10.98 | $23.39 |