- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.33 / $93.33 / $104.71
| Facility | | $93.33 | $93.33 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $19.05 / $141.25
| Professional | | $19.05 | $19.05 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.89 / $6.17 / $10.96
| Professional | | $5.89 | $6.17 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $7.59 / $18.20
| Professional | | $6.03 | $7.59 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.62 / $23.44 / $28.18
| Facility | | $18.62 | $23.44 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $14.79 / $29.51
| Professional | | $14.13 | $14.79 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.35 / $1.51 / $4.17
| Facility | | $0.35 | $1.51 | $4.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $12.59 / $21.38
| Professional | | $10.96 | $12.59 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.35 / $4.17 / $56.23
| Facility | | $0.35 | $4.17 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $21.38 / $25.70
| Professional | | $10.96 | $21.38 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $50.12 / $60.26
| Professional | | $30.20 | $50.12 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Professional | | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.32 / $12.30 / $16.60
| Facility | | $8.32 | $12.30 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.33 / $13.18 / $26.30
| Professional | | $9.33 | $13.18 | $26.30 |