- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.89 / $11.89 / $18.55
| Facility | | $11.89 | $11.89 | $18.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $11.89 / $11.89
| Professional | | $10.27 | $11.89 | $11.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.23 / $14.16 / $24.87
| Facility | | $10.23 | $14.16 | $24.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.39 / $9.39 / $12.68
| Professional | | $6.39 | $9.39 | $12.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.63 / $14.46 / $18.07
| Professional | | $9.63 | $14.46 | $18.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.30 / $11.89 / $21.85
| Facility | | $11.30 | $11.89 | $21.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.89 / $15.02 / $18.55
| Professional | | $11.89 | $15.02 | $18.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.33 / $10.37 / $13.99
| Professional | | $9.33 | $10.37 | $13.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.26 / $10.31 / $10.87
| Professional | | $5.26 | $10.31 | $10.87 |