- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.16 / $10.27 / $11.19
| Facility | | $10.16 | $10.27 | $11.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.26 / $10.27 / $11.19
| Professional | | $10.26 | $10.27 | $11.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.40 / $10.78 / $32.76
| Facility | | $9.40 | $10.78 | $32.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.16 / $10.16 / $10.27
| Professional | | $10.16 | $10.16 | $10.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.09 / $10.27 / $10.27
| Facility | | $10.09 | $10.27 | $10.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $10.27
| Professional | | $10.27 | $10.27 | $10.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $11.14 / $15.00
| Professional | | $10.27 | $11.14 | $15.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.45 / $11.45 / $11.45
| Facility | | $11.45 | $11.45 | $11.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $10.27
| Professional | | $10.27 | $10.27 | $10.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $10.27
| Professional | | $10.27 | $10.27 | $10.27 |