- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.96 / $22.39 / $36.31
| Facility | | $10.96 | $22.39 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $10.96 / $14.13
| Professional | | $10.96 | $10.96 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $25.12 / $50.12
| Facility | | $12.88 | $25.12 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $11.48 / $11.48
| Professional | | $10.96 | $11.48 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $11.22
| Professional | | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $30.20 / $36.31
| Facility | | $11.22 | $30.20 | $36.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $11.75 / $15.14
| Professional | | $10.96 | $11.75 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $11.22
| Professional | | $11.22 | $11.22 | $11.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $10.96 / $11.22
| Facility | | $10.47 | $10.96 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $11.22 / $11.75
| Professional | | $11.22 | $11.22 | $11.75 |