- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.91 / $14.40 / $63.73
| Professional | | $12.91 | $14.40 | $63.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.31 / $66.31 / $76.77
| Facility | | $66.31 | $66.31 | $76.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.76 / $17.26 / $42.86
| Professional | | $16.76 | $17.26 | $42.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.37 / $14.25 / $105.33
| Professional | | $11.37 | $14.25 | $105.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.31 / $14.31 / $105.33
| Professional | | $13.31 | $14.31 | $105.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.73 / $19.05 / $27.01
| Professional | | $11.73 | $19.05 | $27.01 |