- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.13 / $14.13 / $14.13
| Facility | | $14.13 | $14.13 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $14.13 / $25.12
| Professional | | $10.00 | $14.13 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.22 / $16.22 / $16.22
| Facility | | $16.22 | $16.22 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $12.02
| Professional | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.62 / $51.29 / $63.10
| Professional | | $18.62 | $51.29 | $63.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.79 / $18.20 / $26.92
| Facility | | $14.79 | $18.20 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.78 / $19.50 / $26.30
| Professional | | $17.78 | $19.50 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.05 / $23.44 / $23.99
| Facility | | $19.05 | $23.44 | $23.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $23.99 / $23.99
| Professional | | $21.88 | $23.99 | $23.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.80 / $20.89 / $31.62
| Facility | | $13.80 | $20.89 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $22.91 / $70.79
| Professional | | $12.02 | $22.91 | $70.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.95 / $33.88 / $93.33
| Facility | | $19.95 | $33.88 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $26.92 / $26.92
| Professional | | $24.55 | $26.92 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $15.85 / $51.29
| Facility | | $12.88 | $15.85 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $11.75 / $22.39
| Professional | | $10.47 | $11.75 | $22.39 |