- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.22 / $13.22 / $13.22
| Facility | | $13.22 | $13.22 | $13.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.74 / $8.74 / $50.32
| Professional | | $8.74 | $8.74 | $50.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.87 / $10.87 / $10.87
| Facility | | $10.87 | $10.87 | $10.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.24 / $10.87 / $12.51
| Professional | | $9.24 | $10.87 | $12.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.17 / $14.36 / $42.37
| Professional | | $11.17 | $14.36 | $42.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.74 / $19.93 / $22.87
| Facility | | $8.74 | $19.93 | $22.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.86 / $15.31 / $18.04
| Professional | | $1.86 | $15.31 | $18.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.95 / $18.32 / $22.33
| Facility | | $15.95 | $18.32 | $22.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.15 / $16.39 / $20.03
| Professional | | $15.15 | $16.39 | $20.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.74 / $18.98 / $26.51
| Facility | | $8.74 | $18.98 | $26.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.87 / $15.34 / $18.98
| Professional | | $10.87 | $15.34 | $18.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.65 / $24.65 / $29.00
| Facility | | $24.65 | $24.65 | $29.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.72 / $16.72 / $16.72
| Professional | | $16.72 | $16.72 | $16.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.82 / $9.01 / $15.64
| Professional | | $7.82 | $9.01 | $15.64 |