- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.10 / $12.22 / $77.03
| Professional | | $11.10 | $12.22 | $77.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.37 / $23.36 / $35.40
| Facility | | $17.37 | $23.36 | $35.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.17 / $17.04 / $17.37
| Professional | | $8.17 | $17.04 | $17.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.37 / $20.37 / $35.40
| Facility | | $17.37 | $20.37 | $35.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.78 / $11.98 / $17.37
| Professional | | $10.78 | $11.98 | $17.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.03 / $5.03 / $16.48
| Professional | | $5.03 | $5.03 | $16.48 |