- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $20.89 / $33.11
| Facility | | $10.72 | $20.89 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $12.88
| Professional | | $10.00 | $10.00 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $22.91 / $45.71
| Facility | | $12.30 | $22.91 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.47 / $11.22
| Professional | | $10.00 | $10.47 | $11.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $10.47 / $11.48
| Professional | | $10.47 | $10.47 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $25.70 / $33.11
| Facility | | $10.47 | $25.70 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $13.80
| Professional | | $10.00 | $10.00 | $13.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $10.47 / $11.48
| Professional | | $10.47 | $10.47 | $11.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $10.47 / $10.47
| Facility | | $10.47 | $10.47 | $10.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $10.96 / $12.30
| Professional | | $10.47 | $10.96 | $12.30 |