- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.07 / $12.07 / $18.82
| Facility | | $12.07 | $12.07 | $18.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.25 / $12.07 / $15.09
| Professional | | $10.25 | $12.07 | $15.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.38 / $14.37 / $25.24
| Facility | | $10.38 | $14.37 | $25.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.48 / $9.52 / $12.87
| Professional | | $6.48 | $9.52 | $12.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.71 / $14.46 / $18.07
| Professional | | $7.71 | $14.46 | $18.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.47 / $12.07 / $22.18
| Facility | | $11.47 | $12.07 | $22.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.86 / $13.36 / $15.87
| Professional | | $10.86 | $13.36 | $15.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Professional | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.35 / $12.70 / $12.70
| Facility | | $6.35 | $12.70 | $12.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.15 / $12.70 / $14.37
| Professional | | $6.15 | $12.70 | $14.37 |