- 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
- $8.57 / $8.57 / $8.57
| Professional | | $8.57 | $8.57 | $8.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.88 / $36.75 / $36.75
| Facility | | $26.88 | $36.75 | $36.75 |
- 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
- $6.61 / $11.17 / $41.80
| Professional | | $6.61 | $11.17 | $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
- $10.00 / $22.72 / $22.72
| Professional | | $10.00 | $22.72 | $22.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.73 / $11.97 / $25.39
| Professional | | $10.73 | $11.97 | $25.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $135.76 / $135.76
| Facility | | $50.00 | $135.76 | $135.76 |