- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.21 / $18.21 / $18.21
| Facility | | $18.21 | $18.21 | $18.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $12.31 / $71.06
| Professional | | $11.36 | $12.31 | $71.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.93 / $13.93 / $13.93
| Facility | | $13.93 | $13.93 | $13.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.84 / $13.93 / $17.41
| Professional | | $11.84 | $13.93 | $17.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.90 / $20.45 / $58.37
| Professional | | $15.90 | $20.45 | $58.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.36 / $17.05 / $22.72
| Facility | | $11.36 | $17.05 | $22.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.27 / $17.20 / $22.72
| Professional | | $2.27 | $17.20 | $22.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.18 / $22.72 / $29.54
| Facility | | $22.18 | $22.72 | $29.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.19 / $22.72 / $24.64
| Professional | | $22.19 | $22.72 | $24.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.36 / $16.25 / $22.72
| Facility | | $11.36 | $16.25 | $22.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.93 / $19.89 / $22.19
| Professional | | $13.93 | $19.89 | $22.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.11 / $32.11 / $37.78
| Facility | | $32.11 | $32.11 | $37.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.63 / $21.63 / $21.63
| Professional | | $21.63 | $21.63 | $21.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.83 / $10.45 / $20.45
| Professional | | $9.83 | $10.45 | $20.45 |