- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.61 / $28.61 / $30.83
| Facility | | $28.61 | $28.61 | $30.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $10.23 / $10.48
| Professional | | $10.23 | $10.23 | $10.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.75 / $31.75 / $31.75
| Facility | | $31.75 | $31.75 | $31.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.48 / $10.48 / $10.48
| Professional | | $10.48 | $10.48 | $10.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.48 / $10.48 / $10.48
| Facility | | $10.48 | $10.48 | $10.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.48 / $10.48 / $10.48
| Professional | | $10.48 | $10.48 | $10.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.48 / $10.48 / $12.69
| Professional | | $10.48 | $10.48 | $12.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.61 / $28.61 / $30.83
| Facility | | $28.61 | $28.61 | $30.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $10.48 / $30.83
| Professional | | $10.23 | $10.48 | $30.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.34 / $10.27 / $15.41
| Professional | | $3.34 | $10.27 | $15.41 |