- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.48 / $19.66 / $48.60
| Facility | | $16.48 | $19.66 | $48.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.86 / $19.66 / $19.66
| Professional | | $9.86 | $19.66 | $19.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $17.78 / $17.78
| Facility | | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.04 / $21.06 / $23.40
| Professional | | $14.04 | $21.06 | $23.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.04 / $14.81 / $30.80
| Facility | | $11.04 | $14.81 | $30.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.06 / $14.99 / $22.20
| Professional | | $7.06 | $14.99 | $22.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.36 / $12.36 / $14.04
| Facility | | $12.36 | $12.36 | $14.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.55 / $7.75 / $16.76
| Professional | | $6.55 | $7.75 | $16.76 |