- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.86 / $10.10 / $20.20
| Facility | | $8.86 | $10.10 | $20.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.71 / $12.55 / $20.20
| Professional | | $7.71 | $12.55 | $20.20 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $12.53 / $12.53 / $12.53
| Professional | 25 | $12.53 | $12.53 | $12.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.34 / $10.34 / $10.34
| Facility | | $10.34 | $10.34 | $10.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.70 / $19.16 / $33.79
| Professional | | $10.70 | $19.16 | $33.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.08 / $12.08 / $12.08
| Facility | | $12.08 | $12.08 | $12.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.77 / $15.77 / $15.77
| Professional | | $15.77 | $15.77 | $15.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.10 / $17.18 / $30.70
| Facility | | $10.10 | $17.18 | $30.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.52 / $21.26 / $33.65
| Professional | | $11.52 | $21.26 | $33.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.36 / $26.33 / $39.76
| Professional | | $18.36 | $26.33 | $39.76 |