- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.62 / $10.62 / $142.96
| Facility | | $10.62 | $10.62 | $142.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.62 / $10.62 / $36.40
| Professional | | $10.62 | $10.62 | $36.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.41 / $18.51 / $35.64
| Facility | | $10.41 | $18.51 | $35.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.50 / $10.62 / $10.62
| Professional | | $8.50 | $10.62 | $10.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.98 / $29.80 / $34.68
| Facility | | $19.98 | $29.80 | $34.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.91 / $12.67 / $13.72
| Professional | | $10.91 | $12.67 | $13.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.23 / $27.09 / $39.40
| Facility | | $17.23 | $27.09 | $39.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.80 / $10.80 / $14.69
| Professional | | $10.80 | $10.80 | $14.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.11 / $22.24 / $79.48
| Facility | | $15.11 | $22.24 | $79.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.62 / $10.62 / $19.12
| Professional | | $10.62 | $10.62 | $19.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.62 / $10.62 / $19.25
| Professional | | $10.62 | $10.62 | $19.25 |