- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.96 / $11.96 / $11.96
| Facility | | $11.96 | $11.96 | $11.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.64 / $11.96 / $20.37
| Professional | | $11.64 | $11.96 | $20.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.86 / $55.16 / $126.07
| Facility | | $8.86 | $55.16 | $126.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.42 / $18.39 / $26.72
| Professional | | $10.42 | $18.39 | $26.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.64 / $17.64 / $52.42
| Facility | | $17.64 | $17.64 | $52.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.89 / $17.89 / $19.20
| Professional | | $17.89 | $17.89 | $19.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.71 / $14.00 / $16.44
| Facility | | $12.71 | $14.00 | $16.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.74 / $13.97 / $31.88
| Professional | | $12.74 | $13.97 | $31.88 |
- 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
- $22.31 / $22.31 / $23.43
| Professional | | $22.31 | $22.31 | $23.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.35 / $9.35 / $9.35
| Professional | | $9.35 | $9.35 | $9.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.16 / $126.07 / $126.07
| Facility | | $55.16 | $126.07 | $126.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.10 / $13.65 / $37.26
| Professional | | $9.10 | $13.65 | $37.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.67 / $14.30 / $26.72
| Professional | | $9.67 | $14.30 | $26.72 |