- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $10.96 / $12.02
| Facility | | $10.96 | $10.96 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.32 / $12.02 / $16.98
| Professional | | $8.32 | $12.02 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.49 / $15.49 / $15.49
| Professional | | $15.49 | $15.49 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.92 / $26.92 / $79.43
| Facility | | $26.92 | $26.92 | $79.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.49 / $13.49 / $13.49
| Facility | | $13.49 | $13.49 | $13.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $9.77 / $13.49
| Professional | | $9.77 | $9.77 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $102.33
| Facility | | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $147.91 / $147.91
| Professional | | $128.82 | $147.91 | $147.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.23 / $19.50 / $28.18
| Facility | | $10.23 | $19.50 | $28.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.91 / $12.02 / $22.91
| Professional | | $8.91 | $12.02 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $15.14 / $17.38
| Professional | | $15.14 | $15.14 | $17.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.23 / $19.05 / $28.84
| Facility | | $10.23 | $19.05 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $9.77 / $13.49
| Professional | | $9.77 | $9.77 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.17 / $9.77 / $22.91
| Facility | | $6.17 | $9.77 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $11.75 / $14.13
| Professional | | $8.13 | $11.75 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $26.92 / $26.92
| Professional | | $26.92 | $26.92 | $26.92 |