- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.03 / $13.33 / $13.33
| Facility | | $11.03 | $13.33 | $13.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.03 / $13.33 / $14.80
| Professional | | $11.03 | $13.33 | $14.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.94 / $26.94 / $28.61
| Facility | | $26.94 | $26.94 | $28.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.01 / $15.01 / $19.16
| Professional | | $15.01 | $15.01 | $19.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.15 / $14.15 / $18.42
| Professional | | $14.15 | $14.15 | $18.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.39 / $15.39 / $15.39
| Facility | | $15.39 | $15.39 | $15.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.23 / $11.23 / $11.23
| Professional | | $11.23 | $11.23 | $11.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.86 / $24.25 / $32.33
| Professional | | $18.86 | $24.25 | $32.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.93 / $16.36 / $30.22
| Facility | | $7.93 | $16.36 | $30.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.00 / $33.68 / $44.87
| Professional | | $16.00 | $33.68 | $44.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.33 / $20.34 / $34.40
| Facility | | $10.33 | $20.34 | $34.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.33 / $20.34 / $34.40
| Professional | | $10.33 | $20.34 | $34.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.26 / $12.18 / $14.22
| Facility | | $9.26 | $12.18 | $14.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.16 / $13.45 / $20.20
| Professional | | $11.16 | $13.45 | $20.20 |