- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $12.88 / $13.80
| Facility | | $12.88 | $12.88 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $12.88 / $22.91
| Professional | | $12.02 | $12.88 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $31.62 / $177.83
| Facility | | $30.20 | $31.62 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $21.38 / $31.62
| Professional | | $12.02 | $21.38 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.70 / $29.51 / $39.81
| Facility | | $25.70 | $29.51 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $23.99 / $23.99
| Professional | | $18.62 | $23.99 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.39 / $22.39 / $22.39
| Facility | | $22.39 | $22.39 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $16.22 / $22.39
| Professional | | $16.22 | $16.22 | $22.39 |
- 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
- $25.70 / $25.70 / $38.90
| Professional | | $25.70 | $25.70 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.07 / $66.07 / $66.07
| Facility | | $66.07 | $66.07 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $16.60 / $16.98
| Professional | | $16.60 | $16.60 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $31.62 / $177.83
| Facility | | $30.20 | $31.62 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $21.88 / $31.62
| Professional | | $12.02 | $21.88 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $16.60 / $48.98
| Facility | | $0.02 | $16.60 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $16.60 / $25.70
| Professional | | $11.48 | $16.60 | $25.70 |