- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $10.96 / $10.96
| Facility | | $10.96 | $10.96 | $10.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $15.14 / $25.12
| Professional | | $10.96 | $15.14 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.91 / $26.92 / $125.89
| Facility | | $22.91 | $26.92 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $20.89 / $38.90
| Professional | | $10.72 | $20.89 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $17.78 / $53.70
| Facility | | $17.78 | $17.78 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $17.78 / $19.05
| Professional | | $17.78 | $17.78 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $14.13 / $16.60
| Facility | | $12.59 | $14.13 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $14.13 / $16.60
| Professional | | $12.88 | $14.13 | $16.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.18 / $4,897.79 / $9,772.37
| Facility | | $83.18 | $4,897.79 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.99 / $23.99 / $36.31
| Professional | | $23.99 | $23.99 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.33 / $9.33 / $9.33
| Professional | | $9.33 | $9.33 | $9.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.91 / $26.92 / $125.89
| Facility | | $22.91 | $26.92 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $21.38 / $41.69
| Professional | | $10.72 | $21.38 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $10.47 / $15.85
| Facility | | $0.02 | $10.47 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $15.85 / $24.55
| Professional | | $10.47 | $15.85 | $24.55 |