- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $21.82
| Facility | | $10.54 | $10.54 | $21.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.53 / $10.65 / $13.28
| Professional | | $10.53 | $10.65 | $13.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.44 / $11.50 / $11.64
| Facility | | $11.44 | $11.50 | $11.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.76 / $11.50 / $11.64
| Professional | | $9.76 | $11.50 | $11.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $13.43 / $16.91
| Professional | | $10.54 | $13.43 | $16.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.12 / $12.73 / $18.97
| Facility | | $12.12 | $12.73 | $18.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.12 / $13.70 / $1,253.85
| Professional | | $12.12 | $13.70 | $1,253.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $13.14
| Professional | | $10.54 | $10.54 | $13.14 |