- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $12.88 / $12.88
| Facility | | $12.88 | $12.88 | $12.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.03 / $10.96 / $19.05
| Professional | | $6.03 | $10.96 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.18 / $13.18 / $13.18
| Facility | | $13.18 | $13.18 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $11.22
| Professional | | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.45 / $40.74 / $47.86
| Professional | | $14.45 | $40.74 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.80 / $14.45 / $22.39
| Facility | | $13.80 | $14.45 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $14.79 / $20.42
| Professional | | $14.13 | $14.79 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.79 / $18.20 / $20.42
| Facility | | $14.79 | $18.20 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $18.62 / $20.42
| Professional | | $16.60 | $18.62 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $16.98 / $24.55
| Facility | | $10.96 | $16.98 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $17.78 / $70.79
| Professional | | $11.22 | $17.78 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $20.89 / $20.89
| Professional | | $19.05 | $20.89 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.24 / $7.24 / $8.51
| Facility | | $7.24 | $7.24 | $8.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.51 / $9.33 / $17.78
| Professional | | $8.51 | $9.33 | $17.78 |