- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.06 / $19.39 / $29.42
| Professional | | $15.06 | $19.39 | $29.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.36 / $30.61 / $50.00
| Professional | | $22.36 | $30.61 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.23 / $56.58 / $101.63
| Professional | | $19.23 | $56.58 | $101.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.87 / $23.11 / $32.50
| Facility | | $15.87 | $23.11 | $32.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.22 / $40.00 / $72.00
| Professional | | $30.22 | $40.00 | $72.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.20 / $30.40 / $40.00
| Professional | | $27.20 | $30.40 | $40.00 |