- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.30 / $12.46 / $22.76
| Facility | | $10.30 | $12.46 | $22.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.40 / $13.23
| Professional | | $10.30 | $10.40 | $13.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.43 / $16.61 / $32.91
| Facility | | $10.43 | $16.61 | $32.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $10.50
| Professional | | $10.30 | $10.30 | $10.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.72 / $10.30 / $10.30
| Facility | | $9.72 | $10.30 | $10.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $10.30
| Professional | | $10.30 | $10.30 | $10.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $12.36
| Professional | | $10.30 | $10.30 | $12.36 |