- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.49 / $7.49 / $7.49
| Facility | | $7.49 | $7.49 | $7.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.83 / $7.49 / $12.46
| Professional | | $4.83 | $7.49 | $12.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.83 / $35.31 / $81.42
| Facility | | $11.83 | $35.31 | $81.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.70 / $11.53 / $16.73
| Professional | | $6.70 | $11.53 | $16.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.49 / $11.49 / $34.13
| Facility | | $11.49 | $11.49 | $34.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.81 / $11.22 / $11.22
| Professional | | $10.81 | $11.22 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.86 / $9.36 / $10.29
| Facility | | $7.86 | $9.36 | $10.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.40 / $8.75 / $19.88
| Professional | | $5.40 | $8.75 | $19.88 |
- 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
- $13.97 / $13.97 / $14.67
| Professional | | $13.97 | $13.97 | $14.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.19 / $9.19 / $9.19
| Professional | | $9.19 | $9.19 | $9.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.79 / $81.42 / $81.42
| Facility | | $34.79 | $81.42 | $81.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.70 / $8.55 / $23.33
| Professional | | $5.70 | $8.55 | $23.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.94 / $10.94 / $11.53
| Professional | | $10.94 | $10.94 | $11.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.06 / $8.55 / $16.73
| Professional | | $6.06 | $8.55 | $16.73 |