- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.20 / $18.63 / $32.40
| Facility | | $16.20 | $18.63 | $32.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.80 / $18.63 / $18.63
| Professional | | $11.80 | $18.63 | $18.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.88 / $16.84 / $22.66
| Facility | | $13.88 | $16.84 | $22.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.17 / $9.65 / $13.46
| Professional | | $9.17 | $9.65 | $13.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.53 / $13.88 / $50.32
| Facility | | $10.53 | $13.88 | $50.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.21 / $10.14 / $23.23
| Professional | | $7.21 | $10.14 | $23.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.80 / $8.10 / $18.43
| Professional | | $6.80 | $8.10 | $18.43 |