- 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
- Facility
- Modifier
- Low / Median / High Price
- $22.32 / $24.61 / $26.78
| Facility | | $22.32 | $24.61 | $26.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.35 / $10.35 / $10.35
| Professional | | $10.35 | $10.35 | $10.35 |
- 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 / $25.30 / $36.28
| Professional | | $11.24 | $25.30 | $36.28 |
- 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
- $19.34 / $19.72 / $22.66
| Professional | | $19.34 | $19.72 | $22.66 |
- 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 |