- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.49 / $20.64 / $24.27
| Facility | | $11.49 | $20.64 | $24.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.53 / $10.96 / $34.85
| Professional | | $10.53 | $10.96 | $34.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.12 / $12.12 / $12.12
| Professional | | $12.12 | $12.12 | $12.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.64 / $11.07 / $33.61
| Facility | | $9.64 | $11.07 | $33.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $12.58
| Professional | | $10.54 | $10.54 | $12.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $13.54
| Facility | | $10.54 | $10.54 | $13.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $10.54
| Professional | | $10.54 | $10.54 | $10.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.44 / $11.44 / $17.42
| Professional | | $11.44 | $11.44 | $17.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.74 / $14.74 / $14.74
| Facility | | $14.74 | $14.74 | $14.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $10.54
| Professional | | $10.54 | $10.54 | $10.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $11.17
| Professional | | $10.54 | $10.54 | $11.17 |