- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.18 / $16.39 / $18.63
| Professional | | $16.18 | $16.39 | $18.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.00 / $28.00 / $32.00
| Professional | | $21.00 | $28.00 | $32.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.73 / $24.94 / $33.57
| Professional | | $18.73 | $24.94 | $33.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.01 / $30.74 / $53.91
| Professional | | $20.01 | $30.74 | $53.91 |