- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.73 / $9.83 / $623.03
| Facility | | $6.73 | $9.83 | $623.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.73 / $6.73 / $8.47
| Professional | | $6.73 | $6.73 | $8.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.05 / $20.61 / $263.70
| Facility | | $11.05 | $20.61 | $263.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.73 / $7.07 / $2,103.23
| Professional | | $6.73 | $7.07 | $2,103.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.21 / $8.26 / $16.05
| Facility | | $7.21 | $8.26 | $16.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.02 / $11.25 / $13.98
| Professional | | $8.02 | $11.25 | $13.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.66 / $6.73 / $6.73
| Facility | | $6.66 | $6.73 | $6.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.73 / $6.73 / $7.43
| Professional | | $6.73 | $6.73 | $7.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.12 / $53.00 / $8,090.00
| Facility | | $7.12 | $53.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.73 / $6.73 / $6.73
| Professional | | $6.73 | $6.73 | $6.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.73 / $6.73 / $7.79
| Professional | | $6.73 | $6.73 | $7.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.00 / $163.41 / $240.68
| Facility | | $104.00 | $163.41 | $240.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.37 / $263.70 / $263.70
| Facility | | $112.37 | $263.70 | $263.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.73 / $7.13 / $2,103.23
| Professional | | $6.73 | $7.13 | $2,103.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.46 / $85.45 / $95.45
| Facility | | $7.46 | $85.45 | $95.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.73 / $7.07 / $19.93
| Professional | | $6.73 | $7.07 | $19.93 |