- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.76 / $11.76 / $1,124.25
| Facility | | $11.76 | $11.76 | $1,124.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.76 / $11.76 / $11.76
| Professional | | $11.76 | $11.76 | $11.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.43 / $13.22 / $14.84
| Facility | | $11.43 | $13.22 | $14.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.14 / $10.14 / $10.14
| Professional | | $10.14 | $10.14 | $10.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.71 / $19.76 / $28.36
| Facility | | $14.71 | $19.76 | $28.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.14 / $10.14 / $10.14
| Professional | | $10.14 | $10.14 | $10.14 |