- 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 / $9.00 / $12.29
| Professional | | $5.81 | $9.00 | $12.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.83 / $34.60 / $41.66
| Facility | | $28.83 | $34.60 | $41.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.86 / $13.86 / $13.86
| Professional | | $13.86 | $13.86 | $13.86 |
- 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 / $20.65 / $41.80
| Professional | | $11.24 | $20.65 | $41.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.72 / $22.72 / $23.16
| Facility | | $22.72 | $22.72 | $23.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.89 / $22.72 / $22.72
| Professional | | $16.89 | $22.72 | $22.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.73 / $12.08 / $22.63
| Professional | | $10.73 | $12.08 | $22.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $135.76 / $135.76
| Facility | | $50.00 | $135.76 | $135.76 |