- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.52 / $20.65 / $32.64
| Professional | | $16.52 | $20.65 | $32.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.95 / $20.66 / $40.08
| Facility | | $16.95 | $20.66 | $40.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.00 / $106.00 / $106.00
| Professional | | $106.00 | $106.00 | $106.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.00 / $27.00 / $27.00
| Facility | | $27.00 | $27.00 | $27.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.11 / $24.00 / $31.00
| Professional | | $18.11 | $24.00 | $31.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.26 / $23.79 / $28.76
| Professional | | $17.26 | $23.79 | $28.76 |