- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $9.33 / $10.72
| Professional | | $7.41 | $9.33 | $10.72 |
- 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 / $29.51
| Facility | | $6.03 | $14.45 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.12 / $10.23 / $14.45
| Professional | | $9.12 | $10.23 | $14.45 |