- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.27 / $13.04 / $26.82
| Facility | | $10.27 | $13.04 | $26.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $10.37
| Professional | | $10.27 | $10.27 | $10.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.47 / $11.14 / $8,639.91
| Facility | | $9.47 | $11.14 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.66 / $10.66 / $10.66
| Professional | | $10.66 | $10.66 | $10.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.69 / $10.27 / $10.27
| Facility | | $9.69 | $10.27 | $10.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $10.27
| Professional | | $10.27 | $10.27 | $10.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.27 / $15.04 / $26.82
| Facility | | $10.27 | $15.04 | $26.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $13.04
| Professional | | $10.27 | $10.27 | $13.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.69 / $10.27 / $10.27
| Facility | | $9.69 | $10.27 | $10.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $10.27
| Professional | | $10.27 | $10.27 | $10.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.81 / $9.81 / $11.38
| Facility | | $9.81 | $9.81 | $11.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.81 / $9.81 / $11.38
| Professional | | $9.81 | $9.81 | $11.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $14.50
| Professional | | $10.27 | $10.27 | $14.50 |