- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $14.28
| Facility | | $10.27 | $10.27 | $14.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.68 / $12.19
| Professional | | $10.27 | $10.68 | $12.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.30 / $27.52 / $129.60
| Facility | | $11.30 | $27.52 | $129.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $12.99
| Professional | | $10.27 | $10.27 | $12.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.02 / $13.10 / $27.93
| Facility | | $11.02 | $13.10 | $27.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $10.27
| Facility | | $10.27 | $10.27 | $10.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $10.27
| Professional | | $10.27 | $10.27 | $10.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.36 / $53.00 / $8,090.00
| Facility | | $10.36 | $53.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $34.67
| Professional | | $10.27 | $10.27 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $129.60
| Facility | | $75.00 | $75.00 | $129.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $15.41
| Professional | | $10.27 | $10.27 | $15.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $15.41
| Professional | | $10.27 | $10.27 | $15.41 |