- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $15.85 / $25.12
| Professional | | $10.96 | $15.85 | $25.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.18 / $16.98 / $34.67
| Facility | | $13.18 | $16.98 | $34.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $15.85 / $60.26
| Professional | | $10.96 | $15.85 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $45.71 / $52.48
| Professional | | $44.67 | $45.71 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $14.79 / $27.54
| Facility | | $12.59 | $14.79 | $27.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $21.88 / $60.26
| Professional | | $15.14 | $21.88 | $60.26 |