- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.92 / $16.17 / $22.53
| Professional | | $15.92 | $16.17 | $22.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.10 / $12.40 / $12.41
| Professional | | $10.10 | $12.40 | $12.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.70 / $29.18 / $35.08
| Professional | | $21.70 | $29.18 | $35.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.68 / $15.41 / $42.49
| Professional | | $10.68 | $15.41 | $42.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.92 / $20.29 / $35.25
| Facility | | $15.92 | $20.29 | $35.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.64 / $33.35 / $164.61
| Professional | | $16.64 | $33.35 | $164.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.64 / $17.51 / $43.89
| Professional | | $16.64 | $17.51 | $43.89 |