- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.32 / $17.32 / $17.32
| Facility | | $17.32 | $17.32 | $17.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.85 / $10.00 / $56.87
| Professional | | $9.85 | $10.00 | $56.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.24 / $13.24 / $13.24
| Facility | | $13.24 | $13.24 | $13.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.25 / $13.24 / $15.97
| Professional | | $11.25 | $13.24 | $15.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.80 / $17.73 / $55.56
| Professional | | $13.80 | $17.73 | $55.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.85 / $17.19 / $19.72
| Facility | | $9.85 | $17.19 | $19.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.97 / $14.80 / $19.71
| Professional | | $1.97 | $14.80 | $19.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.04 / $19.71 / $21.68
| Facility | | $18.04 | $19.71 | $21.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.04 / $19.71 / $20.04
| Professional | | $18.04 | $19.71 | $20.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.85 / $16.37 / $22.85
| Facility | | $9.85 | $16.37 | $22.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.24 / $17.26 / $19.25
| Professional | | $13.24 | $17.26 | $19.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.87 / $27.87 / $32.78
| Facility | | $27.87 | $27.87 | $32.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.76 / $18.76 / $18.76
| Professional | | $18.76 | $18.76 | $18.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.27 / $9.83 / $19.67
| Professional | | $9.27 | $9.83 | $19.67 |