- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.40 / $10.40 / $40.14
| Facility | | $10.40 | $10.40 | $40.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $10.40 / $10.40
| Professional | | $10.40 | $10.40 | $10.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.46 / $8.11 / $9.53
| Professional | | $7.46 | $8.11 | $9.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.05 / $11.05 / $11.05
| Facility | | $11.05 | $11.05 | $11.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.05 / $11.05 / $11.05
| Professional | | $11.05 | $11.05 | $11.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.40 / $10.40 / $15.43
| Facility | | $10.40 | $10.40 | $15.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.00 / $13.00 / $13.00
| Professional | | $13.00 | $13.00 | $13.00 |