- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.64 / $10.64 / $11.64
| Facility | | $10.64 | $10.64 | $11.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.36 / $10.64 / $13.03
| Professional | | $8.36 | $10.64 | $13.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.63 / $7.63 / $11.62
| Professional | | $7.63 | $7.63 | $11.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.60 / $9.60 / $9.60
| Professional | | $9.60 | $9.60 | $9.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.34 / $10.34 / $20.18
| Facility | | $10.34 | $10.34 | $20.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.78 / $8.78 / $8.78
| Professional | | $8.78 | $8.78 | $8.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.64 / $20.14 / $27.55
| Professional | | $14.64 | $20.14 | $27.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.64 / $13.83 / $25.50
| Facility | | $10.64 | $13.83 | $25.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.35 / $27.00 / $40.36
| Professional | | $11.35 | $27.00 | $40.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.31 / $15.08 / $26.98
| Facility | | $12.31 | $15.08 | $26.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.31 / $15.08 / $26.98
| Professional | | $12.31 | $15.08 | $26.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.00 / $8.59 / $14.32
| Professional | | $8.00 | $8.59 | $14.32 |