- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.30 / $11.03 / $22.77
| Facility | | $10.30 | $11.03 | $22.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $24.52
| Professional | | $10.30 | $10.30 | $24.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.75 / $11.66 / $11.66
| Facility | | $8.75 | $11.66 | $11.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.08 / $11.53 / $11.66
| Professional | | $11.08 | $11.53 | $11.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.50 / $13.13
| Professional | | $10.30 | $10.50 | $13.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.30 / $11.03 / $100.00
| Facility | | $10.30 | $11.03 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $11.33
| Professional | | $10.30 | $10.30 | $11.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.36 / $16.57 / $23.37
| Facility | | $12.36 | $16.57 | $23.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.17 / $13.90 / $24.46
| Professional | | $11.17 | $13.90 | $24.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.78 / $10.30 / $11.33
| Professional | | $9.78 | $10.30 | $11.33 |