- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.85 / $15.85 / $15.85
| Facility | | $15.85 | $15.85 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $19.05 / $53.70
| Professional | | $15.14 | $19.05 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $39.81 / $223.87
| Facility | | $34.67 | $39.81 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $28.84 / $39.81
| Professional | | $16.22 | $28.84 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.39 / $22.39 / $67.61
| Facility | | $22.39 | $22.39 | $67.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $32.36 / $32.36
| Professional | | $25.12 | $32.36 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.39 / $22.91 / $26.92
| Facility | | $22.39 | $22.91 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $16.98 / $22.91
| Professional | | $16.98 | $16.98 | $22.91 |
- 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
- $33.88 / $33.88 / $51.29
| Professional | | $33.88 | $33.88 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.89 / $20.89 / $20.89
| Professional | | $20.89 | $20.89 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $39.81 / $223.87
| Facility | | $34.67 | $39.81 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $29.51 / $42.66
| Professional | | $16.22 | $29.51 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.03 / $22.39 / $48.98
| Facility | | $0.03 | $22.39 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $22.39 / $33.88
| Professional | | $15.14 | $22.39 | $33.88 |