- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.48 / $18.64 / $60.60
| Facility | | $16.48 | $18.64 | $60.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.86 / $18.64 / $18.64
| Professional | | $9.86 | $18.64 | $18.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.52 / $15.52 / $15.52
| Facility | | $15.52 | $15.52 | $15.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.25 / $18.38 / $20.42
| Professional | | $12.25 | $18.38 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.27 / $14.81 / $30.80
| Facility | | $10.27 | $14.81 | $30.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.06 / $14.99 / $19.62
| Professional | | $7.06 | $14.99 | $19.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.25 / $12.25 / $12.25
| Facility | | $12.25 | $12.25 | $12.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.72 / $7.61 / $16.80
| Professional | | $5.72 | $7.61 | $16.80 |