- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.40 / $19.22 / $52.16
| Facility | | $12.40 | $19.22 | $52.16 |
- Facility/Professional
- Facility
- Modifier
- 25
- Low / Median / High Price
- $48.83 / $63.63 / $63.63
| Facility | 25 | $48.83 | $63.63 | $63.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.57 / $14.04 / $28.50
| Professional | | $10.57 | $14.04 | $28.50 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $14.79 / $27.15 / $48.50
| Professional | 25 | $14.79 | $27.15 | $48.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.40 / $15.06 / $17.00
| Facility | | $13.40 | $15.06 | $17.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.33 / $15.70 / $26.89
| Professional | | $11.33 | $15.70 | $26.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.71 / $15.71 / $15.71
| Facility | | $15.71 | $15.71 | $15.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.86 / $16.87 / $27.52
| Professional | | $11.86 | $16.87 | $27.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.84 / $16.84 / $16.84
| Facility | | $16.84 | $16.84 | $16.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.47 / $16.34 / $28.46
| Professional | | $12.47 | $16.34 | $28.46 |