- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.71 / $20.65 / $44.24
| Professional | | $16.71 | $20.65 | $44.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.96 / $27.75 / $88.13
| Professional | | $13.96 | $27.75 | $88.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.64 / $26.73 / $33.70
| Professional | | $25.64 | $26.73 | $33.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.00 / $77.00 / $86.34
| Facility | | $77.00 | $77.00 | $86.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.88 / $22.50 / $165.72
| Professional | | $17.88 | $22.50 | $165.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.56 / $20.72 / $103.41
| Professional | | $12.56 | $20.72 | $103.41 |