- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.19 / $19.19 / $19.19
| Facility | | $19.19 | $19.19 | $19.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.61 / $19.19 / $24.37
| Professional | | $15.61 | $19.19 | $24.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.47 / $70.00 / $70.00
| Facility | | $39.47 | $70.00 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.31 / $12.50 / $46.58
| Professional | | $5.31 | $12.50 | $46.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.83 / $12.00 / $16.00
| Professional | | $7.83 | $12.00 | $16.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.12 / $17.50 / $139.88
| Facility | | $6.12 | $17.50 | $139.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.44 / $6.25 / $17.50
| Professional | | $5.44 | $6.25 | $17.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.86 / $13.38 / $25.02
| Professional | | $9.86 | $13.38 | $25.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.03 / $10.39 / $10.72
| Facility | | $7.03 | $10.39 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.47 / $39.47 / $39.47
| Facility | | $39.47 | $39.47 | $39.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.47 / $39.47 / $39.47
| Professional | | $39.47 | $39.47 | $39.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.79 / $63.79 / $97.86
| Facility | | $63.79 | $63.79 | $97.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.50 / $12.50 / $12.50
| Professional | | $12.50 | $12.50 | $12.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.72 / $10.47 / $15.67
| Professional | | $6.72 | $10.47 | $15.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.34 / $6.34 / $6.34
| Professional | | $6.34 | $6.34 | $6.34 |