- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.49 / $14.49 / $14.49
| Facility | | $14.49 | $14.49 | $14.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.14 / $14.49 / $19.84
| Professional | | $12.14 | $14.49 | $19.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.17 / $50.47 / $154.33
| Facility | | $18.17 | $50.47 | $154.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.70 / $20.19 / $32.36
| Professional | | $13.70 | $20.19 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.18 / $19.18 / $56.96
| Facility | | $19.18 | $19.18 | $56.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.71 / $30.48 / $30.48
| Professional | | $21.71 | $30.48 | $30.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.62 / $19.18 / $23.24
| Facility | | $16.62 | $19.18 | $23.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.13 / $16.62 / $28.88
| Professional | | $12.13 | $16.62 | $28.88 |
- 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
- $26.83 / $26.83 / $28.17
| Professional | | $26.83 | $26.83 | $28.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.44 / $16.44 / $16.44
| Professional | | $16.44 | $16.44 | $16.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.47 / $154.33 / $154.33
| Facility | | $50.47 | $154.33 | $154.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.40 / $17.72 / $32.36
| Professional | | $12.40 | $17.72 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.25 / $16.25 / $16.25
| Facility | | $16.25 | $16.25 | $16.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.40 / $17.72 / $30.54
| Professional | | $12.40 | $17.72 | $30.54 |