- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.60 / $19.95 / $26.92
| Facility | | $16.60 | $19.95 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.62 / $1.17 / $1.58
| Facility | | $0.62 | $1.17 | $1.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $24.55 / $102.33
| Professional | | $10.72 | $24.55 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $14.79 / $31.62
| Facility | | $12.02 | $14.79 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.12 / $12.88 / $34.67
| Professional | | $9.12 | $12.88 | $34.67 |