- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.55 / $21.67 / $28.73
| Professional | | $16.55 | $21.67 | $28.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.85 / $32.56 / $46.68
| Professional | | $23.85 | $32.56 | $46.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.70 / $31.62 / $49.43
| Professional | | $21.70 | $31.62 | $49.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.93 / $25.73 / $34.58
| Facility | | $18.93 | $25.73 | $34.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.96 / $43.27 / $84.57
| Professional | | $30.96 | $43.27 | $84.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.86 / $36.00 / $75.65
| Professional | | $26.86 | $36.00 | $75.65 |