- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.87 / $12.87 / $68.59
| Facility | | $12.87 | $12.87 | $68.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.42 / $10.42 / $12.87
| Professional | | $10.42 | $10.42 | $12.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.45 / $17.18 / $130.22
| Facility | | $12.45 | $17.18 | $130.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.15 / $5.15 / $14.89
| Professional | | $5.15 | $5.15 | $14.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.22 / $17.89 / $27.47
| Facility | | $15.22 | $17.89 | $27.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.09 / $17.52 / $18.59
| Professional | | $13.09 | $17.52 | $18.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.87 / $12.87 / $15.59
| Professional | | $12.87 | $12.87 | $15.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.87 / $12.87 / $68.59
| Facility | | $12.87 | $12.87 | $68.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.42 / $11.04 / $12.87
| Professional | | $10.42 | $11.04 | $12.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.72 / $10.52 / $25.42
| Professional | | $7.72 | $10.52 | $25.42 |