- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.32 / $34.83 / $46.93
| Facility | | $12.32 | $34.83 | $46.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.32 / $12.32 / $12.32
| Professional | | $12.32 | $12.32 | $12.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.32 / $18.98 / $32.11
| Professional | | $12.32 | $18.98 | $32.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.62 / $11.62 / $12.32
| Facility | | $11.62 | $11.62 | $12.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $10.47 / $12.32
| Professional | | $10.47 | $10.47 | $12.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.21 / $12.32 / $19.97
| Professional | | $11.21 | $12.32 | $19.97 |