- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.68 / $17.68 / $17.68
| Facility | | $17.68 | $17.68 | $17.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.47 / $17.68 / $17.92
| Professional | | $12.47 | $17.68 | $17.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.58 / $84.14 / $112.18
| Facility | | $8.58 | $84.14 | $112.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.22 / $16.64 / $31.54
| Professional | | $2.22 | $16.64 | $31.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.51 / $11.49 / $17.12
| Facility | | $1.51 | $11.49 | $17.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.86 / $14.02 / $18.80
| Professional | | $1.86 | $14.02 | $18.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.26 / $15.26 / $20.03
| Facility | | $15.26 | $15.26 | $20.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.26 / $17.12 / $20.03
| Professional | | $15.26 | $17.12 | $20.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.87 / $16.42 / $23.51
| Professional | | $1.87 | $16.42 | $23.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.46 / $10.61 / $17.12
| Professional | | $1.46 | $10.61 | $17.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $12.31 / $19.53
| Professional | | $9.02 | $12.31 | $19.53 |