- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.03 / $37.04 / $37.04
| Facility | | $0.03 | $37.04 | $37.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.04 / $37.04 / $37.04
| Professional | | $37.04 | $37.04 | $37.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.81 / $10.39 / $12.29
| Professional | | $5.81 | $10.39 | $12.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.66 / $30.76 / $34.39
| Facility | | $28.66 | $30.76 | $34.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.56 / $63.16 / $63.16
| Facility | | $0.56 | $63.16 | $63.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.24 / $23.05 / $25.30
| Professional | | $11.24 | $23.05 | $25.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.72 / $19.72 / $20.09
| Facility | | $19.72 | $19.72 | $20.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.18 / $19.72 / $22.48
| Professional | | $9.18 | $19.72 | $22.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.72 / $12.72 / $22.57
| Facility | | $12.72 | $12.72 | $22.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.44 / $11.49 / $22.30
| Professional | | $9.44 | $11.49 | $22.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $135.76 / $135.76
| Facility | | $50.00 | $135.76 | $135.76 |