- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.94 / $7.94 / $7.94
| Facility | | $7.94 | $7.94 | $7.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $7.94 / $25.12
| Professional | | $5.01 | $7.94 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $16.22 / $89.13
| Facility | | $12.30 | $16.22 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.92 / $15.14 / $30.90
| Professional | | $6.92 | $15.14 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.70 / $29.51 / $38.90
| Facility | | $25.70 | $29.51 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $20.42 / $26.30
| Professional | | $14.45 | $20.42 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $7.41 / $7.41
| Professional | | $7.41 | $7.41 | $7.41 |
- 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
- $12.88 / $12.88 / $19.50
| Professional | | $12.88 | $12.88 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $17.78 / $21.88
| Professional | | $9.77 | $17.78 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $16.22 / $89.13
| Facility | | $12.30 | $16.22 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.92 / $15.14 / $30.90
| Professional | | $6.92 | $15.14 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.85 / $15.85 / $18.62
| Facility | | $15.85 | $15.85 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.92 / $12.02 / $17.38
| Professional | | $6.92 | $12.02 | $17.38 |