- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.84 / $14.48 / $26.87
| Professional | | $7.84 | $14.48 | $26.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.05 / $22.04 / $36.83
| Professional | | $9.05 | $22.04 | $36.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.02 / $14.02 / $14.02
| Facility | | $14.02 | $14.02 | $14.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.65 / $16.16 / $37.69
| Professional | | $10.65 | $16.16 | $37.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.73 / $24.56 / $33.14
| Professional | | $12.73 | $24.56 | $33.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.62 / $24.39 / $47.64
| Professional | | $10.62 | $24.39 | $47.64 |