- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.46 / $12.12 / $24.73
| Professional | | $7.46 | $12.12 | $24.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.30 / $47.00 / $100.86
| Facility | | $42.30 | $47.00 | $100.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.75 / $16.41 / $24.97
| Professional | | $7.75 | $16.41 | $24.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.85 / $37.85 / $37.85
| Facility | | $37.85 | $37.85 | $37.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.67 / $22.36 / $43.77
| Professional | | $9.67 | $22.36 | $43.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.88 / $24.01 / $36.11
| Professional | | $17.88 | $24.01 | $36.11 |