- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.78 / $10.03 / $21.15
| Facility | | $9.78 | $10.03 | $21.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.78 / $10.03 / $11.63
| Professional | | $9.78 | $10.03 | $11.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.99 / $22.36 / $42.88
| Facility | | $8.99 | $22.36 | $42.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.40 / $10.40 / $10.40
| Facility | | $10.40 | $10.40 | $10.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $10.40 / $10.40
| Professional | | $10.40 | $10.40 | $10.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $100.00 / $100.00
| Facility | | $75.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.81 / $673.81 / $673.81
| Professional | | $673.81 | $673.81 | $673.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.07 / $10.40 / $15.26
| Facility | | $4.07 | $10.40 | $15.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.36 / $5.96 / $9.18
| Professional | | $3.36 | $5.96 | $9.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.50 / $7.50 / $27.40
| Professional | | $6.50 | $7.50 | $27.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.07 / $10.40 / $15.06
| Facility | | $4.07 | $10.40 | $15.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $10.40 / $12.24
| Professional | | $10.40 | $10.40 | $12.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.19 / $10.81 / $11.35
| Professional | | $10.19 | $10.81 | $11.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.19 / $10.19 / $14.28
| Professional | | $10.19 | $10.19 | $14.28 |