- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.53 / $11.65 / $1,711.50
| Professional | | $11.53 | $11.65 | $1,711.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.15 / $13.15 / $33.08
| Facility | | $13.15 | $13.15 | $33.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.54 / $11.54 / $13.15
| Professional | | $11.54 | $11.54 | $13.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.15 / $13.15 / $33.08
| Facility | | $13.15 | $13.15 | $33.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.54 / $12.51 / $16.32
| Professional | | $11.54 | $12.51 | $16.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.54 / $11.54 / $11.54
| Professional | | $11.54 | $11.54 | $11.54 |