- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $10.96 / $11.48
| Professional | | $10.72 | $10.96 | $11.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $27.54 / $33.88
| Professional | | $10.72 | $27.54 | $33.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $112.20 / $112.20
| Facility | | $47.86 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $10.23 / $15.49
| Professional | | $9.77 | $10.23 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.03 / $14.45 / $32.36
| Facility | | $6.03 | $14.45 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.55 / $10.23 / $14.79
| Professional | | $9.55 | $10.23 | $14.79 |