- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.16 / $10.16 / $10.27
| Facility | | $10.16 | $10.16 | $10.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.16 / $10.27 / $17.05
| Professional | | $10.16 | $10.27 | $17.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.72 / $11.05 / $11.63
| Facility | | $8.72 | $11.05 | $11.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.93 / $11.39 / $11.63
| Professional | | $10.93 | $11.39 | $11.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.46 / $13.08
| Professional | | $10.27 | $10.46 | $13.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.16 / $10.27 / $129.60
| Facility | | $10.16 | $10.27 | $129.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.16 / $10.16 / $15.00
| Professional | | $10.16 | $10.16 | $15.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.11 / $16.23 / $21.57
| Facility | | $12.11 | $16.23 | $21.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.62 / $12.20 / $15.14
| Professional | | $11.62 | $12.20 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.76 / $10.27 / $15.00
| Professional | | $9.76 | $10.27 | $15.00 |