- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $10.27
| Facility | | $10.27 | $10.27 | $10.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.88 / $10.27 / $17.37
| Professional | | $9.88 | $10.27 | $17.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.08 / $47.42 / $109.82
| Facility | | $13.08 | $47.42 | $109.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.33 / $19.28 / $22.68
| Professional | | $11.33 | $19.28 | $22.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.59 / $17.59 / $17.59
| Facility | | $17.59 | $17.59 | $17.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.23 / $20.50 / $20.50
| Professional | | $17.23 | $20.50 | $20.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.00 / $15.26 / $20.03
| Facility | | $15.00 | $15.26 | $20.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.97 / $15.26 / $33.75
| Professional | | $12.97 | $15.26 | $33.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.67 / $18.67 / $18.67
| Professional | | $18.67 | $18.67 | $18.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.56 / $10.56 / $10.56
| Professional | | $10.56 | $10.56 | $10.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.42 / $109.82 / $109.82
| Facility | | $47.42 | $109.82 | $109.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.71 / $11.57 / $19.48
| Professional | | $8.71 | $11.57 | $19.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.72 / $12.69 / $23.43
| Professional | | $8.72 | $12.69 | $23.43 |