- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.49 / $28.49 / $30.70
| Facility | | $28.49 | $28.49 | $30.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.27 / $12.78 / $14.51
| Professional | | $12.27 | $12.78 | $14.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.92 / $13.65 / $38.92
| Facility | | $10.92 | $13.65 | $38.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $12.28 / $12.74
| Professional | | $12.28 | $12.28 | $12.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.28 / $12.28 / $26.52
| Facility | | $12.28 | $12.28 | $26.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $12.28 / $12.28
| Professional | | $12.28 | $12.28 | $12.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $12.28 / $12.28
| Professional | | $12.28 | $12.28 | $12.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.49 / $28.49 / $30.70
| Facility | | $28.49 | $28.49 | $30.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.27 / $12.78 / $20.14
| Professional | | $12.27 | $12.78 | $20.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $12.28 / $17.80
| Professional | | $12.28 | $12.28 | $17.80 |