- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.07 / $18.48 / $32.14
| Facility | | $16.07 | $18.48 | $32.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.10 / $18.48 / $18.48
| Professional | | $11.10 | $18.48 | $18.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.59 / $11.64 / $15.66
| Facility | | $9.59 | $11.64 | $15.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.56 / $7.96 / $11.12
| Professional | | $7.56 | $7.96 | $11.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.45 / $13.28 / $50.32
| Facility | | $10.45 | $13.28 | $50.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.17 / $9.22 / $23.23
| Professional | | $7.17 | $9.22 | $23.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.75 / $6.75 / $16.76
| Professional | | $6.75 | $6.75 | $16.76 |