- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $12.59 / $14.45
| Facility | | $12.59 | $12.59 | $14.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $12.88 / $15.14
| Professional | | $12.02 | $12.88 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $95.50 / $125.89
| Facility | | $54.95 | $95.50 | $125.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $77.62 / $81.28
| Professional | | $12.59 | $77.62 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.75 / $12.59 / $12.59
| Facility | | $11.75 | $12.59 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $12.59 / $48.98
| Professional | | $12.59 | $12.59 | $48.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $13.18 / $15.49
| Facility | | $12.59 | $13.18 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.59 / $13.18 / $15.49
| Professional | | $12.59 | $13.18 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $11.22
| Professional | | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.79 / $14.79 / $14.79
| Facility | | $14.79 | $14.79 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.75 / $12.59 / $15.49
| Professional | | $11.75 | $12.59 | $15.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.76 / $7.76 / $7.76
| Professional | | $7.76 | $7.76 | $7.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.41 / $7.41 / $7.41
| Facility | | $7.41 | $7.41 | $7.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.01 / $12.59 / $17.38
| Professional | | $5.01 | $12.59 | $17.38 |