- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.98 / $22.39 / $42.66
| Facility | | $16.98 | $22.39 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $12.30 / $28.84
| Professional | | $12.02 | $12.30 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $33.88 / $50.12
| Facility | | $10.47 | $33.88 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $23.44 / $56.23
| Professional | | $11.75 | $23.44 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $12.02
| Facility | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $12.02
| Professional | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $15.85 / $75.86
| Facility | | $12.02 | $15.85 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $12.02
| Professional | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $19.95
| Facility | | $12.02 | $12.02 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $12.02
| Professional | | $12.02 | $12.02 | $12.02 |