- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.92 / $12.92 / $89.86
| Facility | | $12.92 | $12.92 | $89.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $10.47 / $16.98
| Professional | | $10.47 | $10.47 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.50 / $17.25 / $130.63
| Facility | | $12.50 | $17.25 | $130.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.17 / $5.17 / $14.94
| Professional | | $5.17 | $5.17 | $14.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.22 / $17.89 / $27.56
| Facility | | $15.22 | $17.89 | $27.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.09 / $15.96 / $18.59
| Professional | | $13.09 | $15.96 | $18.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.92 / $12.92 / $15.65
| Professional | | $12.92 | $12.92 | $15.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.92 / $12.92 / $89.86
| Facility | | $12.92 | $12.92 | $89.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $12.92 / $15.43
| Professional | | $10.47 | $12.92 | $15.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.75 / $10.55 / $25.51
| Professional | | $7.75 | $10.55 | $25.51 |