- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.00 / $12.02 / $19.95
| Facility | | $10.00 | $12.02 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $6.03 / $14.45
| Professional | | $5.01 | $6.03 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $11.48 / $11.48
| Professional | | $11.48 | $11.48 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.41 / $7.41 / $10.00
| Facility | | $7.41 | $7.41 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.24 / $10.72 / $10.72
| Professional | | $7.24 | $10.72 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.13 / $8.71 / $16.98
| Facility | | $5.13 | $8.71 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.80 / $5.37 / $9.33
| Professional | | $3.80 | $5.37 | $9.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $13.18 / $13.18
| Professional | | $13.18 | $13.18 | $13.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.17 / $5.75 / $6.46
| Facility | | $4.17 | $5.75 | $6.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.69 / $3.89 / $10.72
| Professional | | $2.69 | $3.89 | $10.72 |