- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.98 / $16.57 / $25.17
| Facility | | $10.98 | $16.57 | $25.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.98 / $11.09 / $15.31
| Professional | | $10.98 | $11.09 | $15.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.36 / $23.72 / $46.76
| Facility | | $9.36 | $23.72 | $46.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.07 / $8.07 / $8.07
| Professional | | $8.07 | $8.07 | $8.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.06 / $446.06 / $446.06
| Facility | | $446.06 | $446.06 | $446.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.36 / $10.98 / $10.98
| Facility | | $10.36 | $10.98 | $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
- 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
- $5.05 / $10.98 / $16.17
| Facility | | $5.05 | $10.98 | $16.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.21 / $10.98 / $19.93
| Professional | | $8.21 | $10.98 | $19.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.83 / $10.98 / $15.86
| Facility | | $6.83 | $10.98 | $15.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.39 / $10.98 / $19.89
| Professional | | $10.39 | $10.98 | $19.89 |
- 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
- $10.94 / $10.99 / $14.82
| Professional | | $10.94 | $10.99 | $14.82 |