- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.52 / $10.52 / $13.05
| Facility | | $10.52 | $10.52 | $13.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.52 / $10.52 / $14.62
| Professional | | $10.52 | $10.52 | $14.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.67 / $9.67 / $12.87
| Professional | | $9.67 | $9.67 | $12.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.05 / $13.05 / $13.05
| Professional | | $13.05 | $13.05 | $13.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.60 / $11.60 / $14.33
| Facility | | $11.60 | $11.60 | $14.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.86 / $9.86 / $13.65
| Professional | | $9.86 | $9.86 | $13.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.48 / $17.02 / $23.17
| Professional | | $14.48 | $17.02 | $23.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.28 / $11.60 / $20.27
| Facility | | $5.28 | $11.60 | $20.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.00 / $22.36 / $28.35
| Professional | | $12.00 | $22.36 | $28.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.22 / $13.46 / $25.05
| Facility | | $11.22 | $13.46 | $25.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $13.44 / $24.18
| Professional | | $11.22 | $13.44 | $24.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.51 / $8.49 / $13.81
| Professional | | $7.51 | $8.49 | $13.81 |