- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.22 / $25.12 / $58.88
| Facility | | $16.22 | $25.12 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $12.88 / $16.98
| Professional | | $10.96 | $12.88 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $16.98 / $16.98
| Professional | | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.22 / $16.22 / $47.86
| Facility | | $16.22 | $16.22 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.62 / $6.46 / $13.49
| Professional | | $5.62 | $6.46 | $13.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $19.95
| Facility | | $12.02 | $12.02 | $19.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $16.22 / $30.90
| Facility | | $10.47 | $16.22 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.33 / $26.92 / $30.90
| Professional | | $9.33 | $26.92 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.24 / $16.22 / $16.22
| Facility | | $7.24 | $16.22 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.76 / $9.55 / $16.22
| Professional | | $6.76 | $9.55 | $16.22 |