- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.76 / $21.56 / $24.20
| Facility | | $10.76 | $21.56 | $24.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.76 / $10.86 / $18.52
| Professional | | $10.76 | $10.86 | $18.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.78 / $17.19 / $38.13
| Facility | | $10.78 | $17.19 | $38.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.76 / $10.78 / $23.70
| Professional | | $10.76 | $10.78 | $23.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.66 / $13.81 / $24.10
| Facility | | $12.66 | $13.81 | $24.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $10.96 / $29.36
| Professional | | $10.96 | $10.96 | $29.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.15 / $10.15 / $10.76
| Facility | | $10.15 | $10.15 | $10.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.76 / $10.76 / $10.76
| Professional | | $10.76 | $10.76 | $10.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.68 / $12.91 / $24.75
| Professional | | $9.68 | $12.91 | $24.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $85.00 / $100.00
| Facility | | $75.00 | $85.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.15 / $10.76 / $15.16
| Facility | | $10.15 | $10.76 | $15.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.76 / $10.76 / $23.27
| Professional | | $10.76 | $10.76 | $23.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.61 / $15.61 / $15.61
| Professional | | $15.61 | $15.61 | $15.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.60 / $9.68 / $11.83
| Professional | | $8.60 | $9.68 | $11.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.76 / $10.76 / $22.18
| Professional | | $10.76 | $10.76 | $22.18 |