- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.65 / $16.85 / $46.01
| Facility | | $13.65 | $16.85 | $46.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.65 / $13.65 / $16.85
| Professional | | $13.65 | $13.65 | $16.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.30 / $22.49 / $144.57
| Facility | | $16.30 | $22.49 | $144.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.74 / $6.74 / $16.88
| Professional | | $6.74 | $6.74 | $16.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.13 / $23.83 / $35.93
| Facility | | $23.13 | $23.83 | $35.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.02 / $19.44 / $24.47
| Professional | | $17.02 | $19.44 | $24.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.85 / $16.85 / $20.41
| Professional | | $16.85 | $16.85 | $20.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.37 / $16.85 / $46.01
| Facility | | $16.37 | $16.85 | $46.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.65 / $13.65 / $16.85
| Professional | | $13.65 | $13.65 | $16.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.11 / $11.68 / $28.22
| Professional | | $10.11 | $11.68 | $28.22 |