- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $13.50 / $75.48
| Professional | | $9.77 | $13.50 | $75.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.02 / $22.89 / $34.69
| Facility | | $17.02 | $22.89 | $34.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.78 / $16.52 / $17.02
| Professional | | $5.78 | $16.52 | $17.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.18 / $19.96 / $34.69
| Facility | | $12.18 | $19.96 | $34.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.57 / $10.57 / $17.02
| Professional | | $10.57 | $10.57 | $17.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.79 / $4.93 / $11.74
| Professional | | $4.79 | $4.93 | $11.74 |