- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.71 / $25.00 / $29.64
| Professional | | $15.71 | $25.00 | $29.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.62 / $15.62 / $17.19
| Facility | | $15.62 | $15.62 | $17.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.09 / $13.09 / $15.62
| Professional | | $13.09 | $13.09 | $15.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.71 / $25.01 / $36.78
| Facility | | $15.71 | $25.01 | $36.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.82 / $31.02 / $160.35
| Professional | | $25.82 | $31.02 | $160.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.47 / $30.08 / $52.92
| Professional | | $25.47 | $30.08 | $52.92 |