- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.06 / $10.06 / $16.75
| Facility | | $10.06 | $10.06 | $16.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.74 / $10.06 / $13.58
| Professional | | $7.74 | $10.06 | $13.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.14 / $8.56 / $20.60
| Professional | | $7.14 | $8.56 | $20.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.89 / $15.85 / $21.40
| Facility | | $11.89 | $15.85 | $21.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $15.85 / $33.94
| Professional | | $10.30 | $15.85 | $33.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.23 / $9.23 / $18.57
| Facility | | $9.23 | $9.23 | $18.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.47 / $7.85 / $9.23
| Professional | | $6.47 | $7.85 | $9.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.23 / $9.23 / $9.52
| Facility | | $9.23 | $9.23 | $9.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.47 / $9.23 / $9.23
| Professional | | $6.47 | $9.23 | $9.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.48 / $11.66 / $15.28
| Professional | | $8.48 | $11.66 | $15.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.05 / $7.46 / $10.35
| Professional | | $5.05 | $7.46 | $10.35 |