- 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
- $7.94 / $10.00 / $18.20
| Professional | | $7.94 | $10.00 | $18.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.95 / $20.42 / $95.50
| Facility | | $19.95 | $20.42 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $16.22 / $21.88
| Professional | | $8.32 | $16.22 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.30 / $31.62 / $41.69
| Facility | | $26.30 | $31.62 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $13.80 / $13.80
| Professional | | $13.80 | $13.80 | $13.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $13.49 / $14.79
| Facility | | $12.30 | $13.49 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $9.77 / $13.49
| Professional | | $9.77 | $9.77 | $13.49 |
- 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
- $18.62 / $18.62 / $28.18
| Professional | | $18.62 | $18.62 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $11.75 / $11.75
| Professional | | $11.75 | $11.75 | $11.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.95 / $20.42 / $95.50
| Facility | | $19.95 | $20.42 | $95.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $16.22 / $23.99
| Professional | | $8.71 | $16.22 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.92 / $11.22 / $25.12
| Facility | | $6.92 | $11.22 | $25.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $11.75 / $18.62
| Professional | | $8.32 | $11.75 | $18.62 |