- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $19.05 / $24.55
| Facility | | $10.96 | $19.05 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $10.96 / $14.13
| Professional | | $10.96 | $10.96 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.33 / $22.39 / $42.66
| Facility | | $9.33 | $22.39 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $8.13 / $8.13
| Professional | | $8.13 | $8.13 | $8.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $446.68 / $446.68
| Facility | | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $11.22 / $11.22
| Facility | | $10.47 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $11.22
| Professional | | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $12.30 / $22.91
| Facility | | $10.96 | $12.30 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $10.96 / $12.88
| Professional | | $10.96 | $10.96 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $10.96 / $10.96
| Professional | | $10.96 | $10.96 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.00 / $15.14 / $33.88
| Facility | | $10.00 | $15.14 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $10.72 / $12.02
| Professional | | $10.72 | $10.72 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $11.22 / $11.22
| Facility | | $10.96 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $11.22
| Professional | | $11.22 | $11.22 | $11.22 |