- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.23 / $50.81 / $103.82
| Facility | | $13.23 | $50.81 | $103.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.67 / $11.21 / $13.20
| Professional | | $6.67 | $11.21 | $13.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.73 / $8.73 / $17.73
| Professional | | $8.73 | $8.73 | $17.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.58 / $52.46 / $52.46
| Facility | | $26.58 | $52.46 | $52.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.66 / $8.18 / $13.25
| Professional | | $5.66 | $8.18 | $13.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.59 / $13.32 / $32.92
| Facility | | $8.59 | $13.32 | $32.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.99 / $9.30 / $18.07
| Professional | | $7.99 | $9.30 | $18.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.06 / $11.41 / $24.61
| Facility | | $10.06 | $11.41 | $24.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.13 / $18.02 / $23.00
| Professional | | $17.13 | $18.02 | $23.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,539.68 / $1,539.68 / $1,539.68
| Facility | | $1,539.68 | $1,539.68 | $1,539.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.99 / $8.78 / $17.16
| Professional | | $6.99 | $8.78 | $17.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $72.00 / $100.00
| Facility | | $50.00 | $72.00 | $100.00 |