- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.08 / $7.08 / $7.08
| Facility | | $7.08 | $7.08 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $7.08 / $8.91
| Professional | | $7.08 | $7.08 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.94 / $120.23 / $125.89
| Facility | | $7.94 | $120.23 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.41 / $7.94 / $7.94
| Facility | | $7.41 | $7.94 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $7.94 / $7.94
| Professional | | $7.94 | $7.94 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.11 / $33.11 / $33.11
| Professional | | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.94 / $8.13 / $120.23
| Facility | | $7.94 | $8.13 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $7.94 / $223.87
| Professional | | $7.08 | $7.94 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $7.41 / $32.36
| Professional | | $7.08 | $7.41 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $13.49 / $15.85
| Professional | | $12.02 | $13.49 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.76 / $8.13 / $144.54
| Facility | | $7.76 | $8.13 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Professional | | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.94 / $83.18 / $125.89
| Professional | | $7.94 | $83.18 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $125.89 / $125.89
| Professional | | $7.41 | $125.89 | $125.89 |