- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.22 / $9.22 / $9.22
| Facility | | $9.22 | $9.22 | $9.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.22 / $9.72 / $12.45
| Professional | | $9.22 | $9.72 | $12.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.47 / $60.12 / $96.08
| Facility | | $16.47 | $60.12 | $96.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.36 / $15.10 / $20.61
| Professional | | $8.36 | $15.10 | $20.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.88 / $31.48 / $40.36
| Facility | | $25.88 | $31.48 | $40.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.65 / $13.65 / $13.81
| Professional | | $13.65 | $13.65 | $13.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.19 / $13.40 / $14.78
| Facility | | $12.19 | $13.40 | $14.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $13.40 / $24.00
| Professional | | $9.77 | $13.40 | $24.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $4,618.00 / $9,239.00
| Facility | | $83.43 | $4,618.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.07 / $17.07 / $17.93
| Professional | | $17.07 | $17.07 | $17.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.88 / $11.88 / $11.88
| Professional | | $11.88 | $11.88 | $11.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.98 / $96.08 / $96.08
| Facility | | $41.98 | $96.08 | $96.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.67 / $10.52 / $20.61
| Professional | | $7.67 | $10.52 | $20.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.67 / $9.11 / $9.78
| Facility | | $7.67 | $9.11 | $9.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.24 / $10.81 / $20.18
| Professional | | $8.24 | $10.81 | $20.18 |