- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.39 / $10.39 / $10.39
| Facility | | $10.39 | $10.39 | $10.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.39 / $10.39 / $12.57
| Professional | | $10.39 | $10.39 | $12.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.19 / $15.58 / $25.28
| Facility | | $10.19 | $15.58 | $25.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.74 / $10.91 / $10.92
| Professional | | $8.74 | $10.91 | $10.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.08 / $16.13 / $33.96
| Facility | | $13.08 | $16.13 | $33.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.61 / $11.67 / $13.48
| Professional | | $10.61 | $11.67 | $13.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.58 / $16.23 / $36.95
| Facility | | $12.58 | $16.23 | $36.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.61 / $10.61 / $11.28
| Professional | | $10.61 | $10.61 | $11.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.60 / $10.39 / $18.70
| Facility | | $9.60 | $10.39 | $18.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.39 / $11.57 / $26.72
| Professional | | $10.39 | $11.57 | $26.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.39 / $11.01 / $19.88
| Professional | | $10.39 | $11.01 | $19.88 |