- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $33.88 / $48.98
| Facility | | $12.88 | $33.88 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $15.14 / $26.92
| Professional | | $10.96 | $15.14 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $34.67 / $42.66
| Professional | | $21.88 | $34.67 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.50 / $32.36 / $165.96
| Professional | | $19.50 | $32.36 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $22.91 / $48.98
| Facility | | $17.78 | $22.91 | $48.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $21.38 / $44.67
| Professional | | $10.72 | $21.38 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $21.88 / $22.91
| Professional | | $21.38 | $21.88 | $22.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.88 / $21.88 / $21.88
| Facility | | $21.88 | $21.88 | $21.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $17.78 / $39.81
| Facility | | $17.78 | $17.78 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $11.48 / $40.74
| Professional | | $10.72 | $11.48 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $17.78 / $17.78
| Professional | | $14.13 | $17.78 | $17.78 |