- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.32 / $10.25 / $81.66
| Professional | | $9.32 | $10.25 | $81.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.42 / $24.77 / $37.53
| Facility | | $18.42 | $24.77 | $37.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.97 / $18.07 / $18.42
| Professional | | $6.97 | $18.07 | $18.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.54 / $21.59 / $37.53
| Facility | | $12.54 | $21.59 | $37.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.43 / $11.43 / $18.42
| Professional | | $11.43 | $11.43 | $18.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.62 / $7.62 / $13.79
| Professional | | $7.62 | $7.62 | $13.79 |