- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.14 / $5.50 / $13.68
| Facility | | $3.14 | $5.50 | $13.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.80 / $6.83 / $7.10
| Professional | | $3.80 | $6.83 | $7.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.83 / $6.83 / $22.30
| Professional | | $6.83 | $6.83 | $22.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.38 / $13.38 / $14.05
| Facility | | $13.38 | $13.38 | $14.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.38 / $13.38 / $13.38
| Professional | | $13.38 | $13.38 | $13.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.44 / $6.44 / $19.14
| Facility | | $6.44 | $6.44 | $19.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.83 / $6.83 / $6.83
| Professional | | $6.83 | $6.83 | $6.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.44 / $9.66 / $332.00
| Facility | | $6.44 | $9.66 | $332.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $7.41 / $17.89
| Professional | | $7.41 | $7.41 | $17.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.83 / $6.83 / $7.08
| Facility | | $6.83 | $6.83 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.83 / $6.83 / $7.08
| Professional | | $6.83 | $6.83 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.44 / $6.44 / $555.00
| Facility | | $6.44 | $6.44 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.83 / $7.19 / $15.24
| Professional | | $6.83 | $7.19 | $15.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.83 / $6.83 / $12.31
| Professional | | $6.83 | $6.83 | $12.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.08 / $7.08 / $7.08
| Facility | | $7.08 | $7.08 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.60 / $6.83 / $9.02
| Professional | | $6.60 | $6.83 | $9.02 |