- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.67 / $17.39 / $22.30
| Professional | | $9.67 | $17.39 | $22.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.24 / $11.24 / $11.24
| Professional | | $11.24 | $11.24 | $11.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.07 / $21.37 / $34.35
| Facility | | $14.07 | $21.37 | $34.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.81 / $11.69 / $210.56
| Professional | | $10.81 | $11.69 | $210.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.81 / $11.69 / $16.76
| Professional | | $10.81 | $11.69 | $16.76 |