- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.62 / $10.62 / $19.12
| Facility | | $10.62 | $10.62 | $19.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.62 / $10.62 / $12.85
| Professional | | $10.62 | $10.62 | $12.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.43 / $34.60 / $35.04
| Facility | | $34.43 | $34.60 | $35.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.27 / $34.54 / $35.04
| Professional | | $29.27 | $34.54 | $35.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.80 / $10.91 / $13.72
| Professional | | $10.80 | $10.91 | $13.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.62 / $13.65 / $31.86
| Facility | | $10.62 | $13.65 | $31.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.62 / $10.62 / $11.53
| Professional | | $10.62 | $10.62 | $11.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $10.62 / $11.53
| Professional | | $9.02 | $10.62 | $11.53 |