- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $20.53 / $26.36
| Professional | | $17.05 | $20.53 | $26.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.44 / $17.45 / $28.01
| Professional | | $14.44 | $17.45 | $28.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $22.79 / $34.17
| Professional | | $15.00 | $22.79 | $34.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.52 / $20.78 / $29.20
| Facility | | $17.52 | $20.78 | $29.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.05 / $26.51 / $142.02
| Professional | | $19.05 | $26.51 | $142.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.89 / $22.63 / $41.11
| Professional | | $17.89 | $22.63 | $41.11 |