- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.97 / $22.68 / $10,608.06
| Facility | | $12.97 | $22.68 | $10,608.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.30 / $13.30 / $13.68
| Professional | | $13.30 | $13.30 | $13.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.08 / $20.63 / $32.72
| Facility | | $13.08 | $20.63 | $32.72 |
- 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
- $12.32 / $12.32 / $12.32
| Professional | | $12.32 | $12.32 | $12.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.35 / $14.01 / $85.00
| Facility | | $12.35 | $14.01 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.27 / $12.35 / $12.35
| Professional | | $12.27 | $12.35 | $12.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.32 / $12.32 / $12.32
| Professional | | $12.32 | $12.32 | $12.32 |