- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.86 / $12.86 / $12.86
| Facility | | $12.86 | $12.86 | $12.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.86 / $12.86 / $13.38
| Professional | | $12.86 | $12.86 | $13.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $12.30 / $22.73
| Facility | | $1.00 | $12.30 | $22.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.58 / $13.76 / $14.48
| Professional | | $11.58 | $13.76 | $14.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.77 / $38.18 / $53.66
| Facility | | $20.77 | $38.18 | $53.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.73 / $15.75 / $16.23
| Professional | | $12.73 | $15.75 | $16.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.45 / $34.97 / $48.35
| Facility | | $18.45 | $34.97 | $48.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.60 / $12.60 / $14.76
| Professional | | $12.60 | $12.60 | $14.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.10 / $14.48 / $32.08
| Facility | | $9.10 | $14.48 | $32.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.48 / $14.48 / $28.57
| Professional | | $14.48 | $14.48 | $28.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.86 / $12.86 / $25.37
| Professional | | $12.86 | $12.86 | $25.37 |