- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $20.32
| Facility | | $10.27 | $10.27 | $20.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.26 / $10.27 / $11.09
| Professional | | $10.26 | $10.27 | $11.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.02 / $14.84 / $38.25
| Facility | | $10.02 | $14.84 | $38.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.13 / $10.16 / $10.27
| Professional | | $8.13 | $10.16 | $10.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.50 / $33.56 / $40.86
| Facility | | $19.50 | $33.56 | $40.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.57 / $12.36 / $13.29
| Professional | | $10.57 | $12.36 | $13.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.82 / $30.63 / $38.44
| Facility | | $16.82 | $30.63 | $38.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.46 / $10.46 / $14.23
| Professional | | $10.46 | $10.46 | $14.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.16 / $10.16 / $17.17
| Facility | | $10.16 | $10.16 | $17.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.16 / $10.16 / $14.02
| Professional | | $10.16 | $10.16 | $14.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $18.62
| Professional | | $10.27 | $10.27 | $18.62 |