- 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 / $10.96
| Professional | | $5.01 | $7.08 | $10.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.23 / $12.59 / $79.43
| Facility | | $10.23 | $12.59 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.79 / $9.12 / $12.59
| Professional | | $4.79 | $9.12 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $8.71 / $8.71
| Professional | | $7.76 | $8.71 | $8.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.41 / $7.41 / $9.55
| Facility | | $7.41 | $7.41 | $9.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $6.31 / $8.13
| Professional | | $6.31 | $6.31 | $8.13 |
- 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
- $10.72 / $10.72 / $16.22
| Professional | | $10.72 | $10.72 | $16.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $6.76 / $6.76
| Professional | | $6.76 | $6.76 | $6.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.23 / $12.59 / $79.43
| Facility | | $10.23 | $12.59 | $79.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.79 / $9.33 / $13.80
| Professional | | $4.79 | $9.33 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $7.76 / $8.32
| Professional | | $7.76 | $7.76 | $8.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.89 / $5.62 / $7.08
| Facility | | $3.89 | $5.62 | $7.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.68 / $7.08 / $10.72
| Professional | | $4.68 | $7.08 | $10.72 |