- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.01 / $5.01 / $5.01
| Facility | | $5.01 | $5.01 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $7.08 / $26.30
| Professional | | $5.01 | $7.08 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.55 / $11.75 / $79.43
| Facility | | $9.55 | $11.75 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $9.33 / $16.22
| Professional | | $5.25 | $9.33 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.71 / $8.71 / $26.30
| Facility | | $8.71 | $8.71 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.24 / $7.59 / $7.59
| Professional | | $7.24 | $7.59 | $7.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.37 / $7.94 / $8.13
| Facility | | $5.37 | $7.94 | $8.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.92 / $6.92 / $8.32
| Professional | | $6.92 | $6.92 | $8.32 |
- 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
- $10.00 / $10.00 / $15.49
| Professional | | $10.00 | $10.00 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.92 / $6.92 / $6.92
| Professional | | $6.92 | $6.92 | $6.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.55 / $11.75 / $79.43
| Facility | | $9.55 | $11.75 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $9.33 / $17.78
| Professional | | $5.25 | $9.33 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $7.41 / $7.76
| Professional | | $7.41 | $7.41 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.47 / $5.25 / $7.24
| Facility | | $4.47 | $5.25 | $7.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.79 / $7.08 / $11.22
| Professional | | $4.79 | $7.08 | $11.22 |