- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.20 / $18.20 / $18.20
| Facility | | $18.20 | $18.20 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $26.92 / $52.48
| Professional | | $18.20 | $26.92 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.15 / $42.66 / $229.09
| Facility | | $37.15 | $42.66 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $34.67 / $58.88
| Professional | | $18.62 | $34.67 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.92 / $26.92 / $81.28
| Facility | | $26.92 | $26.92 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $27.54 / $27.54
| Professional | | $26.30 | $27.54 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.91 / $28.84 / $29.51
| Facility | | $22.91 | $28.84 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $24.55 / $31.62
| Professional | | $24.55 | $24.55 | $31.62 |
- 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
- $36.31 / $36.31 / $56.23
| Professional | | $36.31 | $36.31 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $15.85 / $15.85
| Professional | | $15.85 | $15.85 | $15.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.15 / $42.66 / $229.09
| Facility | | $37.15 | $42.66 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $34.67 / $64.57
| Professional | | $19.05 | $34.67 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.03 / $18.62 / $26.30
| Facility | | $0.03 | $18.62 | $26.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $25.12 / $40.74
| Professional | | $16.98 | $25.12 | $40.74 |