- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.87 / $16.60 / $20.93
| Professional | | $12.87 | $16.60 | $20.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.70 / $30.00 / $41.46
| Professional | | $15.70 | $30.00 | $41.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.71 / $24.21 / $42.80
| Professional | | $13.71 | $24.21 | $42.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $12.32 / $15.00 / $22.39
| Facility | 26 | $12.32 | $15.00 | $22.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.52 / $17.80 / $40.79
| Professional | | $12.52 | $17.80 | $40.79 |