- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.78 / $17.87 / $142.94
| Professional | | $14.78 | $17.87 | $142.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.75 / $10.75 / $10.75
| Professional | | $10.75 | $10.75 | $10.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.80 / $31.93 / $56.72
| Professional | | $20.80 | $31.93 | $56.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.41 / $27.57 / $48.53
| Facility | | $21.41 | $27.57 | $48.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.34 / $22.23 / $314.77
| Professional | | $13.34 | $22.23 | $314.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.34 / $19.10 / $29.35
| Professional | | $13.34 | $19.10 | $29.35 |