- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.96 / $23.96 / $23.96
| Facility | | $23.96 | $23.96 | $23.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.57 / $16.39 / $64.54
| Professional | | $6.57 | $16.39 | $64.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.44 / $13.44 / $13.44
| Facility | | $13.44 | $13.44 | $13.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.42 / $11.42 / $16.53
| Professional | | $11.42 | $11.42 | $16.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.42 / $40.47 / $49.49
| Professional | | $13.42 | $40.47 | $49.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.20 / $19.32 / $22.47
| Facility | | $15.20 | $19.32 | $22.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.63 / $18.21 / $23.48
| Professional | | $16.63 | $18.21 | $23.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.76 / $19.26 / $22.36
| Facility | | $17.76 | $19.26 | $22.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.01 / $22.36 / $22.36
| Professional | | $19.01 | $22.36 | $22.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.53 / $19.07 / $22.36
| Facility | | $11.53 | $19.07 | $22.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.42 / $19.59 / $24.60
| Professional | | $11.42 | $19.59 | $24.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.23 / $24.60 / $24.60
| Professional | | $19.23 | $24.60 | $24.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.31 / $8.61 / $8.61
| Facility | | $7.31 | $8.61 | $8.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.85 / $9.49 / $18.18
| Professional | | $8.85 | $9.49 | $18.18 |