- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.92 / $12.92 / $12.92
| Facility | | $12.92 | $12.92 | $12.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.36 / $8.36 / $48.13
| Professional | | $8.36 | $8.36 | $48.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.65 / $10.65 / $10.65
| Facility | | $10.65 | $10.65 | $10.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.05 / $10.65 / $12.06
| Professional | | $9.05 | $10.65 | $12.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.95 / $14.08 / $41.42
| Professional | | $10.95 | $14.08 | $41.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.36 / $18.10 / $20.72
| Facility | | $8.36 | $18.10 | $20.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.64 / $15.05 / $16.42
| Professional | | $1.64 | $15.05 | $16.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.64 / $18.10 / $20.23
| Facility | | $15.64 | $18.10 | $20.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.64 / $16.91 / $19.05
| Professional | | $15.64 | $16.91 | $19.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.86 / $14.68 / $24.06
| Facility | | $6.86 | $14.68 | $24.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.65 / $14.68 / $18.23
| Professional | | $10.65 | $14.68 | $18.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.58 / $23.58 / $27.74
| Facility | | $23.58 | $23.58 | $27.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.99 / $15.99 / $15.99
| Professional | | $15.99 | $15.99 | $15.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.73 / $8.91 / $14.85
| Professional | | $7.73 | $8.91 | $14.85 |