- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.67 / $22.20 / $28.61
| Professional | | $18.67 | $22.20 | $28.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.63 / $21.63 / $36.02
| Professional | | $21.63 | $21.63 | $36.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.32 / $24.15 / $39.03
| Professional | | $16.32 | $24.15 | $39.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.86 / $23.34 / $35.94
| Facility | | $18.86 | $23.34 | $35.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $40.43 / $63.07
| Professional | | $32.34 | $40.43 | $63.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.89 / $23.08 / $35.42
| Professional | | $17.89 | $23.08 | $35.42 |