- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $28.18 / $37.15
| Facility | | $12.30 | $28.18 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $16.98
| Professional | | $12.02 | $12.02 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $13.18 / $5,011.87
| Facility | | $11.22 | $13.18 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $12.59 / $12.59
| Professional | | $12.59 | $12.59 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $12.02
| Facility | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $12.02
| Professional | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.48 / $12.02 / $12.02
| Facility | | $11.48 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $20.89 / $20.89
| Professional | | $18.20 | $20.89 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $23.99 / $37.15
| Facility | | $12.30 | $23.99 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $32.36
| Professional | | $12.02 | $12.02 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $14.13 / $53.70
| Facility | | $11.22 | $14.13 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.68 / $14.13 / $53.70
| Professional | | $4.68 | $14.13 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $12.02
| Facility | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $16.60
| Professional | | $12.02 | $12.02 | $16.60 |