- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $15.25 / $21.47
| Professional | | $13.49 | $15.25 | $21.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.52 / $79.23 / $359.27
| Facility | | $54.52 | $79.23 | $359.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.78 / $21.85 / $21.85
| Professional | | $15.78 | $21.85 | $21.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.64 / $19.64 / $25.84
| Professional | | $19.64 | $19.64 | $25.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.73 / $21.96 / $31.79
| Professional | | $17.73 | $21.96 | $31.79 |