- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.92 / $70.40 / $117.27
| Facility | | $36.92 | $70.40 | $117.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $11.36 / $11.81
| Professional | | $11.36 | $11.36 | $11.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.68 / $11.68 / $35.70
| Facility | | $11.68 | $11.68 | $35.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.36 / $11.36 / $11.36
| Professional | | $11.36 | $11.36 | $11.36 |
- 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
- $6.80 / $11.36 / $11.36
| Professional | | $6.80 | $11.36 | $11.36 |