- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.87 / $12.87 / $20.07
| Facility | | $12.87 | $12.87 | $20.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.11 / $12.87 / $23.46
| Professional | | $11.11 | $12.87 | $23.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.07 / $15.46 / $26.91
| Facility | | $11.07 | $15.46 | $26.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.91 / $10.16 / $13.72
| Professional | | $6.91 | $10.16 | $13.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.42 / $15.69 / $19.62
| Professional | | $10.42 | $15.69 | $19.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.23 / $12.87 / $23.65
| Facility | | $12.23 | $12.87 | $23.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.07 / $16.26 / $20.26
| Professional | | $12.07 | $16.26 | $20.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.09 / $11.22 / $15.14
| Professional | | $10.09 | $11.22 | $15.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.69 / $12.20 / $16.26
| Facility | | $5.69 | $12.20 | $16.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.69 / $10.87 / $11.53
| Professional | | $5.69 | $10.87 | $11.53 |