- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.09 / $51.03 / $230.04
| Facility | | $12.09 | $51.03 | $230.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $11.68 / $14.46
| Professional | | $11.36 | $11.68 | $14.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.58 / $17.04 / $35.11
| Facility | | $13.58 | $17.04 | $35.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $11.36 / $11.68
| Professional | | $11.36 | $11.36 | $11.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.72 / $11.36 / $11.36
| Facility | | $10.72 | $11.36 | $11.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $11.36 / $11.36
| Professional | | $11.36 | $11.36 | $11.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $11.36 / $15.17
| Professional | | $11.36 | $11.36 | $15.17 |