- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.30 / $12.88 / $20.60
| Facility | | $10.30 | $12.88 | $20.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.40 / $24.52
| Professional | | $10.30 | $10.40 | $24.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.72 / $9.72 / $20.60
| Facility | | $9.72 | $9.72 | $20.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $11.17
| Professional | | $10.30 | $10.30 | $11.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $22.74 / $47.66
| Professional | | $10.21 | $22.74 | $47.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.30 / $14.73 / $28.80
| Facility | | $10.30 | $14.73 | $28.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $12.17 / $13.39
| Professional | | $10.30 | $12.17 | $13.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.30 / $12.88 / $30.90
| Facility | | $10.30 | $12.88 | $30.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.72 / $13.86 / $28.80
| Facility | | $9.72 | $13.86 | $28.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $13.13 / $14.84
| Professional | | $10.30 | $13.13 | $14.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.87 / $19.34 / $42.20
| Facility | | $11.87 | $19.34 | $42.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $10.30
| Professional | | $10.30 | $10.30 | $10.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $12.36
| Professional | | $10.30 | $10.30 | $12.36 |