- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.74 / $12.74 / $12.74
| Facility | | $12.74 | $12.74 | $12.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.43 / $17.84 / $46.12
| Professional | | $10.43 | $17.84 | $46.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.55 / $35.18 / $79.48
| Facility | | $13.55 | $35.18 | $79.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.84 / $13.55 / $13.55
| Professional | | $10.84 | $13.55 | $13.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.03 / $48.97 / $117.81
| Facility | | $27.03 | $48.97 | $117.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $19.93 / $25.77
| Professional | | $15.85 | $19.93 | $25.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.76 / $44.77 / $92.76
| Facility | | $26.76 | $44.77 | $92.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.69 / $15.69 / $24.81
| Professional | | $15.69 | $15.69 | $24.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.55 / $27.10 / $64.86
| Facility | | $13.55 | $27.10 | $64.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.69 / $10.01 / $28.75
| Professional | | $5.69 | $10.01 | $28.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.55 / $16.26 / $16.26
| Facility | | $13.55 | $16.26 | $16.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.69 / $10.84 / $28.86
| Professional | | $5.69 | $10.84 | $28.86 |