- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.53 / $14.55 / $1,534.80
| Facility | | $10.53 | $14.55 | $1,534.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.53 / $10.65 / $12.65
| Professional | | $10.53 | $10.65 | $12.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.12 / $12.12 / $13.06
| Professional | | $12.12 | $12.12 | $13.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.06 / $11.06 / $12.17
| Facility | | $11.06 | $11.06 | $12.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.28 / $10.28 / $12.72
| Professional | | $10.28 | $10.28 | $12.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $13.54
| Facility | | $10.54 | $10.54 | $13.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.54 / $10.54 / $11.44
| Professional | | $10.54 | $10.54 | $11.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $13.71 / $17.37
| Professional | | $13.06 | $13.71 | $17.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.01 / $10.54 / $14.60
| Professional | | $10.01 | $10.54 | $14.60 |