- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.71 / $60.26 / $239.88
| Facility | | $8.71 | $60.26 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $8.91 / $13.49
| Professional | | $7.08 | $8.91 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $6.92 / $17.78
| Professional | | $5.75 | $6.92 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $35.48 / $63.10
| Facility | | $12.59 | $35.48 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $6.31 / $11.48
| Professional | | $5.01 | $6.31 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $17.78 / $69.18
| Facility | | $10.72 | $17.78 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.48 / $11.48 / $11.48
| Facility | | $11.48 | $11.48 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.23 / $22.39 / $60.26
| Facility | | $10.23 | $22.39 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.17 / $7.41 / $17.38
| Professional | | $6.17 | $7.41 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.26 / $100.00 / $100.00
| Facility | | $60.26 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.51 / $11.48 / $60.26
| Facility | | $8.51 | $11.48 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.17 / $9.77 / $13.18
| Professional | | $6.17 | $9.77 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $9.77 / $9.77
| Professional | | $8.71 | $9.77 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $1,202.26
| Facility | | $977.24 | $977.24 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.71 / $11.48 / $32.36
| Facility | | $8.71 | $11.48 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.89 / $7.76 / $17.38
| Professional | | $5.89 | $7.76 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.17 / $6.76 / $11.48
| Facility | | $4.17 | $6.76 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.61 / $8.32 / $11.48
| Professional | | $6.61 | $8.32 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.47 / $4.47 / $11.48
| Professional | | $4.47 | $4.47 | $11.48 |