- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.40 / $10.40 / $10.40
| Facility | | $10.40 | $10.40 | $10.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $10.34 / $16.57
| Professional | | $7.41 | $10.34 | $16.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.67 / $24.05 / $30.06
| Professional | | $19.67 | $24.05 | $30.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.46 / $12.52 / $20.30
| Facility | | $10.46 | $12.52 | $20.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.50 / $6.64 / $16.17
| Professional | | $5.50 | $6.64 | $16.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.27 / $23.65 / $38.18
| Facility | | $14.27 | $23.65 | $38.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.27 / $23.07 / $28.87
| Professional | | $14.27 | $23.07 | $28.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.84 / $22.65 / $30.38
| Professional | | $12.84 | $22.65 | $30.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.65 / $5.50 / $10.98
| Professional | | $4.65 | $5.50 | $10.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.06 / $11.06 / $11.06
| Professional | | $11.06 | $11.06 | $11.06 |