- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.77 / $18.77 / $18.77
| Facility | | $18.77 | $18.77 | $18.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.77 / $18.77 / $32.51
| Professional | | $18.77 | $18.77 | $32.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.88 / $122.37 / $204.06
| Facility | | $28.88 | $122.37 | $204.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.78 / $28.88 / $41.95
| Professional | | $16.78 | $28.88 | $41.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.33 / $29.33 / $87.11
| Facility | | $29.33 | $29.33 | $87.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.13 / $30.53 / $30.53
| Professional | | $27.13 | $30.53 | $30.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.46 / $25.81 / $33.83
| Facility | | $23.46 | $25.81 | $33.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.94 / $25.81 / $49.88
| Professional | | $21.94 | $25.81 | $49.88 |
- 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
- $35.02 / $35.02 / $36.77
| Professional | | $35.02 | $35.02 | $36.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.46 / $23.46 / $23.46
| Professional | | $23.46 | $23.46 | $23.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $87.21 / $204.06 / $204.06
| Facility | | $87.21 | $204.06 | $204.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.08 / $21.43 / $41.95
| Professional | | $15.08 | $21.43 | $41.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.78 / $30.75 / $39.02
| Professional | | $16.78 | $30.75 | $39.02 |