- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.66 / $15.46 / $20.68
| Professional | | $13.66 | $15.46 | $20.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.88 / $20.35 / $41.07
| Professional | | $8.88 | $20.35 | $41.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.77 / $18.72 / $51.75
| Professional | | $8.77 | $18.72 | $51.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.56 / $20.59 / $46.78
| Facility | | $14.56 | $20.59 | $46.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.79 / $22.19 / $134.00
| Professional | | $10.79 | $22.19 | $134.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.79 / $18.98 / $38.83
| Professional | | $10.79 | $18.98 | $38.83 |