- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.30 / $10.61 / $22.76
| Facility | | $10.30 | $10.61 | $22.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.40 / $12.46
| Professional | | $10.30 | $10.40 | $12.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.33 / $11.33 / $17.00
| Facility | | $11.33 | $11.33 | $17.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.33 / $11.33 / $11.56
| Professional | | $11.33 | $11.33 | $11.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- 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
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $12.88
| Professional | | $10.30 | $10.30 | $12.88 |