- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.42 / $26.87 / $27.02
| Professional | | $18.42 | $26.87 | $27.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.22 / $118.22 / $118.22
| Facility | | $118.22 | $118.22 | $118.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.57 / $1.57 / $124.50
| Facility | | $1.57 | $1.57 | $124.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.40 / $29.77 / $76.22
| Professional | | $9.40 | $29.77 | $76.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.57 / $1.57 / $124.50
| Facility | | $1.57 | $1.57 | $124.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.40 / $29.77 / $76.22
| Professional | | $9.40 | $29.77 | $76.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.06 / $20.52 / $73.38
| Professional | | $11.06 | $20.52 | $73.38 |