- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.67 / $12.67 / $13.68
| Facility | | $12.67 | $12.67 | $13.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $13.68 / $25.34
| Professional | | $12.59 | $13.68 | $25.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,456.92 / $5,821.21 / $8,577.84
| Facility | | $5,456.92 | $5,821.21 | $8,577.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.77 / $13.77 / $17.23
| Professional | | $13.77 | $13.77 | $17.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.94 / $28.94 / $28.94
| Facility | | $28.94 | $28.94 | $28.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.89 / $16.89 / $16.89
| Facility | | $16.89 | $16.89 | $16.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.34 / $12.34 / $16.89
| Professional | | $12.34 | $12.34 | $16.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.69 / $147.25 / $147.25
| Facility | | $134.69 | $147.25 | $147.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.57 / $166.57 / $197.85
| Professional | | $166.57 | $166.57 | $197.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.13 / $20.17 / $28.94
| Facility | | $8.13 | $20.17 | $28.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.22 / $26.05 / $33.65
| Professional | | $8.22 | $26.05 | $33.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.13 / $19.34 / $28.94
| Facility | | $8.13 | $19.34 | $28.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.34 / $12.34 / $18.01
| Professional | | $12.34 | $12.34 | $18.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.49 / $15.52 / $19.26
| Professional | | $10.49 | $15.52 | $19.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.28 / $17.73 / $28.94
| Professional | | $15.28 | $17.73 | $28.94 |