- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.14 / $15.14 / $15.14
| Facility | | $15.14 | $15.14 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $20.89 / $33.11
| Professional | | $15.14 | $20.89 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.11 / $33.88 / $162.18
| Facility | | $33.11 | $33.88 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $26.30 / $35.48
| Professional | | $13.49 | $26.30 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.44 / $23.44 / $70.79
| Facility | | $23.44 | $23.44 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $24.55 / $24.55
| Professional | | $21.88 | $24.55 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.62 / $20.89 / $23.44
| Facility | | $18.62 | $20.89 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $17.38 / $25.70
| Professional | | $17.38 | $17.38 | $25.70 |
- 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
- $30.20 / $30.20 / $45.71
| Professional | | $30.20 | $30.20 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $18.62 / $18.62
| Professional | | $18.62 | $18.62 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.11 / $33.88 / $162.18
| Facility | | $33.11 | $33.88 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $26.30 / $38.90
| Professional | | $13.49 | $26.30 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $13.18 / $19.50
| Facility | | $0.02 | $13.18 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $19.50 / $30.20
| Professional | | $13.18 | $19.50 | $30.20 |