- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.61 / $9.61 / $9.61
| Facility | | $9.61 | $9.61 | $9.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.61 / $9.61 / $19.37
| Professional | | $9.61 | $9.61 | $19.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.67 / $46.68 / $122.93
| Facility | | $7.67 | $46.68 | $122.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.59 / $14.82 / $22.34
| Professional | | $8.59 | $14.82 | $22.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.19 / $14.19 / $42.14
| Facility | | $14.19 | $14.19 | $42.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.40 / $14.40 / $15.43
| Professional | | $14.40 | $14.40 | $15.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.54 / $15.54 / $16.01
| Facility | | $15.54 | $15.54 | $16.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.56 / $13.21 / $19.20
| Professional | | $10.56 | $13.21 | $19.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.94 / $17.94 / $18.84
| Professional | | $17.94 | $17.94 | $18.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.35 / $11.35 / $11.35
| Professional | | $11.35 | $11.35 | $11.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.54 / $122.93 / $122.93
| Facility | | $52.54 | $122.93 | $122.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.46 / $11.00 / $29.96
| Professional | | $8.46 | $11.00 | $29.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.46 / $10.06 / $12.19
| Facility | | $8.46 | $10.06 | $12.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.46 / $12.59 / $25.37
| Professional | | $8.46 | $12.59 | $25.37 |