- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.91 / $8.91 / $8.91
| Facility | | $8.91 | $8.91 | $8.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $12.02 / $21.88
| Professional | | $8.91 | $12.02 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.20 / $22.91 / $104.71
| Facility | | $18.20 | $22.91 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $15.85 / $22.91
| Professional | | $8.71 | $15.85 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.45 / $14.45 / $43.65
| Facility | | $14.45 | $14.45 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $14.45 / $14.45
| Professional | | $14.13 | $14.45 | $14.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $13.18 / $18.20
| Facility | | $12.02 | $13.18 | $18.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $16.22
| Professional | | $11.22 | $11.22 | $16.22 |
- 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
- $19.50 / $19.50 / $29.51
| Professional | | $19.50 | $19.50 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.08 / $7.08 / $7.08
| Professional | | $7.08 | $7.08 | $7.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.20 / $22.91 / $104.71
| Facility | | $18.20 | $22.91 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $16.98 / $25.12
| Professional | | $8.71 | $16.98 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $8.51 / $12.59
| Facility | | $0.02 | $8.51 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.51 / $12.59 / $19.50
| Professional | | $8.51 | $12.59 | $19.50 |