- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.68 / $18.48 / $24.49
| Facility | | $10.68 | $18.48 | $24.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.67 / $10.77 / $30.66
| Professional | | $10.67 | $10.77 | $30.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.77 / $11.21 / $34.07
| Facility | | $9.77 | $11.21 | $34.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.10 / $10.68 / $10.68
| Professional | | $10.10 | $10.68 | $10.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.68 / $10.68 / $11.27
| Facility | | $10.68 | $10.68 | $11.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $10.68 / $15.11
| Professional | | $10.68 | $10.68 | $15.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.58 / $11.58 / $42.00
| Professional | | $11.58 | $11.58 | $42.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.75 / $15.75 / $15.75
| Facility | | $15.75 | $15.75 | $15.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $10.68 / $10.68
| Professional | | $10.68 | $10.68 | $10.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $10.68 / $11.32
| Professional | | $10.68 | $10.68 | $11.32 |