- 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 / $11.32 / $12.29
| Professional | | $5.81 | $11.32 | $12.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.76 / $32.14 / $38.56
| Facility | | $30.76 | $32.14 | $38.56 |
- 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 / $28.91 / $51.04
| Professional | | $11.24 | $28.91 | $51.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.74 / $27.74 / $28.26
| Facility | | $27.74 | $27.74 | $28.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.66 / $27.74 / $29.55
| Professional | | $22.66 | $27.74 | $29.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.15 / $14.50 / $28.85
| Professional | | $11.15 | $14.50 | $28.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $135.76 / $135.76
| Facility | | $50.00 | $135.76 | $135.76 |