- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.27 / $10.27 / $10.27
| Facility | | $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 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.46 / $10.46 / $13.08
| Professional | | $10.46 | $10.46 | $13.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.11 / $17.17 / $29.34
| Facility | | $12.11 | $17.17 | $29.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.16 / $10.16 / $11.18
| Professional | | $10.16 | $10.16 | $11.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.11 / $12.34 / $17.66
| Facility | | $12.11 | $12.34 | $17.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.51 / $12.20 / $15.14
| Professional | | $11.51 | $12.20 | $15.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.24 / $11.24 / $11.24
| Professional | | $11.24 | $11.24 | $11.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.09 / $10.27 / $11.30
| Professional | | $10.09 | $10.27 | $11.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.16 / $10.16 / $10.16
| Facility | | $10.16 | $10.16 | $10.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.16 / $10.16 / $10.16
| Professional | | $10.16 | $10.16 | $10.16 |