- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.12 / $25.12 / $25.12
| Facility | | $25.12 | $25.12 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $16.98 / $25.12
| Professional | | $12.88 | $16.98 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $83.18
| Professional | | $10.00 | $10.00 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $51.29 / $83.18
| Facility | | $43.65 | $51.29 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $32.36 / $74.13
| Professional | | $11.22 | $32.36 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $18.62 / $28.18
| Facility | | $12.59 | $18.62 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $20.42 / $56.23
| Professional | | $17.38 | $20.42 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $19.05 / $36.31
| Facility | | $12.88 | $19.05 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $13.80 / $147.91
| Professional | | $7.76 | $13.80 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $39.81 / $72.44
| Professional | | $25.12 | $39.81 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.62 / $147.91 / $147.91
| Facility | | $31.62 | $147.91 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $114.82 / $147.91
| Professional | | $11.22 | $114.82 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $77.62 / $79.43
| Professional | | $77.62 | $77.62 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $602.56
| Facility | | $218.78 | $218.78 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.92 / $10.47 / $25.12
| Professional | | $6.92 | $10.47 | $25.12 |