- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $12.02
| Facility | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $12.88
| Professional | | $10.00 | $10.00 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $14.79 / $15.85
| Facility | | $12.02 | $14.79 | $15.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $10.47 / $10.72
| Professional | | $10.47 | $10.47 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.33 / $10.47 / $14.13
| Professional | | $9.33 | $10.47 | $14.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.98 / $21.38 / $38.90
| Facility | | $16.98 | $21.38 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $11.48 / $15.14
| Professional | | $11.48 | $11.48 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $10.72 / $10.72
| Professional | | $10.47 | $10.72 | $10.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $11.22 / $12.59
| Professional | | $10.00 | $11.22 | $12.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $10.47 / $10.47
| Professional | | $10.47 | $10.47 | $10.47 |