- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.27 / $8.27 / $8.27
| Facility | | $8.27 | $8.27 | $8.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.27 / $8.27 / $14.62
| Professional | | $8.27 | $8.27 | $14.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.39 / $40.21 / $91.72
| Facility | | $13.39 | $40.21 | $91.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $12.99 / $19.27
| Professional | | $7.41 | $12.99 | $19.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.21 / $12.21 / $36.26
| Facility | | $12.21 | $12.21 | $36.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.96 / $13.47 / $13.47
| Professional | | $11.96 | $13.47 | $13.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.00 / $11.60 / $14.17
| Facility | | $4.00 | $11.60 | $14.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.86 / $11.60 / $22.50
| Professional | | $9.86 | $11.60 | $22.50 |
- 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
- $15.47 / $15.47 / $16.23
| Professional | | $15.47 | $15.47 | $16.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.95 / $10.95 / $10.95
| Professional | | $10.95 | $10.95 | $10.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.20 / $91.72 / $91.72
| Facility | | $39.20 | $91.72 | $91.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.78 / $9.46 / $18.53
| Professional | | $6.78 | $9.46 | $18.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.94 / $9.64 / $18.53
| Professional | | $6.94 | $9.64 | $18.53 |