- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.51 / $10.51 / $26.28
| Facility | | $10.51 | $10.51 | $26.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.51 / $8.51 / $10.51
| Professional | | $8.51 | $8.51 | $10.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.17 / $14.03 / $77.31
| Facility | | $10.17 | $14.03 | $77.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.20 / $4.20 / $9.61
| Professional | | $4.20 | $4.20 | $9.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $13.43 / $17.47
| Facility | | $10.47 | $13.43 | $17.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $11.98 / $14.97
| Professional | | $10.40 | $11.98 | $14.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.51 / $10.51 / $12.73
| Professional | | $10.51 | $10.51 | $12.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.51 / $10.51 / $26.28
| Facility | | $10.51 | $10.51 | $26.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.51 / $8.51 / $10.51
| Professional | | $8.51 | $8.51 | $10.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.25 / $6.31 / $15.09
| Professional | | $6.25 | $6.31 | $15.09 |