- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.02 / $13.03 / $19.46
| Facility | | $10.02 | $13.03 | $19.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.02 / $10.77 / $12.81
| Professional | | $10.02 | $10.77 | $12.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.82 / $19.82 / $19.82
| Professional | | $19.82 | $19.82 | $19.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.39 / $23.76 / $44.34
| Facility | | $12.39 | $23.76 | $44.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.46 / $8.16 / $10.60
| Professional | | $7.46 | $8.16 | $10.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $10.68 / $13.25
| Professional | | $10.68 | $10.68 | $13.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.68 / $19.54 / $31.26
| Facility | | $10.68 | $19.54 | $31.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.02 / $10.68 / $13.88
| Professional | | $10.02 | $10.68 | $13.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.73 / $10.70 / $15.30
| Professional | | $9.73 | $10.70 | $15.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $11.89 / $13.67
| Professional | | $10.68 | $11.89 | $13.67 |