- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.50 / $11.03 / $45.32
| Facility | | $10.50 | $11.03 | $45.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $11.03 / $14.42
| Professional | | $10.30 | $11.03 | $14.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.25 / $13.24 / $31.13
| Facility | | $11.25 | $13.24 | $31.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.13 / $11.13 / $11.13
| Professional | | $11.13 | $11.13 | $11.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.72 / $9.72 / $10.30
| Facility | | $9.72 | $9.72 | $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
- Facility
- Modifier
- Low / Median / High Price
- $10.30 / $11.03 / $24.00
| Facility | | $10.30 | $11.03 | $24.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $10.51
| Professional | | $10.30 | $10.30 | $10.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $12.60
| Professional | | $10.30 | $10.30 | $12.60 |