- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $14.13 / $19.50
| Professional | | $10.96 | $14.13 | $19.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.18 / $14.13 / $15.14
| Professional | | $13.18 | $14.13 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $12.30 / $15.85
| Professional | | $10.23 | $12.30 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $16.22 / $18.20 / $24.55
| Professional | 50 | $16.22 | $18.20 | $24.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.49 / $16.60 / $19.95
| Facility | | $13.49 | $16.60 | $19.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $15.14 / $20.42
| Professional | | $14.13 | $15.14 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.91 / $22.91 / $22.91
| Facility | | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $16.98 / $72.44
| Professional | | $12.30 | $16.98 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.33 / $32.36 / $33.11
| Professional | | $9.33 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $14.13 / $20.42
| Professional | | $11.48 | $14.13 | $20.42 |