- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.68 / $14.74 / $27.05
| Facility | | $10.68 | $14.74 | $27.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.67 / $10.77 / $13.62
| Professional | | $10.67 | $10.77 | $13.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.68 / $18.09 / $34.18
| Facility | | $10.68 | $18.09 | $34.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $10.68 / $13.56
| Professional | | $10.68 | $10.68 | $13.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.07 / $10.68 / $15.78
| Facility | | $10.07 | $10.68 | $15.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $10.68 / $13.10
| Professional | | $10.68 | $10.68 | $13.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $11.00 / $12.96
| Professional | | $10.68 | $11.00 | $12.96 |