- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.68 / $13.20 / $19.21
| Facility | | $10.68 | $13.20 | $19.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $10.68 / $11.85
| Professional | | $10.68 | $10.68 | $11.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.31 / $32.70 / $134.16
| Facility | | $24.31 | $32.70 | $134.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $11.32 / $424.84
| Professional | | $10.68 | $11.32 | $424.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.45 / $13.12 / $25.48
| Facility | | $11.45 | $13.12 | $25.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.68 / $10.68 / $11.27
| Facility | | $10.68 | $10.68 | $11.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $10.68 / $11.08
| Professional | | $10.68 | $10.68 | $11.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.68 / $53.00 / $8,090.00
| Facility | | $10.68 | $53.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $10.68 / $52.46
| Professional | | $10.68 | $10.68 | $52.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $10.68 / $12.36
| Professional | | $10.68 | $10.68 | $12.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.12 / $296.12 / $296.12
| Facility | | $296.12 | $296.12 | $296.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $134.16 / $134.16
| Facility | | $75.00 | $134.16 | $134.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $11.32 / $424.84
| Professional | | $10.68 | $11.32 | $424.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $11.32 / $31.63
| Professional | | $10.68 | $11.32 | $31.63 |