- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.02 / $3.02 / $3.02
| Facility | | $3.02 | $3.02 | $3.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.02 / $5.01 / $7.94
| Professional | | $3.02 | $5.01 | $7.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.32 / $8.51 / $79.43
| Facility | | $8.32 | $8.51 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.39 / $6.61 / $8.91
| Professional | | $3.39 | $6.61 | $8.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.03 / $6.03 / $18.20
| Facility | | $6.03 | $6.03 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $6.17 / $6.17
| Professional | | $5.50 | $6.17 | $6.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.79 / $5.25 / $5.62
| Facility | | $4.79 | $5.25 | $5.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.47 / $4.47 / $5.62
| Professional | | $4.47 | $4.47 | $5.62 |
- 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
- $7.59 / $7.59 / $11.75
| Professional | | $7.59 | $7.59 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $91.20 / $91.20
| Facility | | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.47 / $4.47 / $4.47
| Professional | | $4.47 | $4.47 | $4.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.32 / $8.51 / $79.43
| Facility | | $8.32 | $8.51 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.39 / $6.76 / $9.77
| Professional | | $3.39 | $6.76 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.82 / $3.98 / $5.01
| Facility | | $2.82 | $3.98 | $5.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.31 / $5.01 / $7.59
| Professional | | $3.31 | $5.01 | $7.59 |