- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $32.36 / $39.81
| Professional | | $10.72 | $32.36 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $169.82 / $169.82
| Facility | | $47.86 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $10.96 / $18.62
| Professional | | $10.23 | $10.96 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.03 / $14.45 / $41.69
| Facility | | $6.03 | $14.45 | $41.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $10.96 / $18.62
| Professional | | $10.23 | $10.96 | $18.62 |