- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $19.05 / $19.05
| Professional | | $19.05 | $19.05 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $17.38 / $34.67
| Professional | | $10.72 | $17.38 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.02 / $47.86 / $69.18
| Facility | | $38.02 | $47.86 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $18.20 / $18.20
| Professional | | $18.20 | $18.20 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.56 / $0.56 / $1.51
| Facility | | $0.56 | $0.56 | $1.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $14.79 / $17.38
| Professional | | $14.13 | $14.79 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $34.67 / $40.74
| Professional | | $34.67 | $34.67 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $8.32 / $28.84
| Professional | | $8.32 | $8.32 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Facility | | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $17.38 / $34.67
| Professional | | $10.72 | $17.38 | $34.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $16.60 / $25.70
| Facility | | $12.02 | $16.60 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.59 / $17.38 / $39.81
| Professional | | $7.59 | $17.38 | $39.81 |