- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.68 / $12.68 / $56.68
| Facility | | $12.68 | $12.68 | $56.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $12.68
| Professional | | $10.27 | $10.27 | $12.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.27 / $16.93 / $128.36
| Facility | | $12.27 | $16.93 | $128.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.07 / $5.07 / $14.67
| Professional | | $5.07 | $5.07 | $14.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.22 / $17.89 / $27.04
| Facility | | $15.22 | $17.89 | $27.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.77 / $17.27 / $18.53
| Professional | | $12.77 | $17.27 | $18.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.68 / $12.68 / $15.36
| Professional | | $12.68 | $12.68 | $15.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.68 / $12.68 / $56.68
| Facility | | $12.68 | $12.68 | $56.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $12.68
| Professional | | $10.27 | $10.27 | $12.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.61 / $10.37 / $25.06
| Professional | | $7.61 | $10.37 | $25.06 |