- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.55 / $18.23 / $25.69
| Professional | | $14.55 | $18.23 | $25.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.79 / $30.41 / $50.55
| Professional | | $15.79 | $30.41 | $50.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.64 / $57.00 / $101.84
| Professional | | $18.64 | $57.00 | $101.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.83 / $21.73 / $29.12
| Facility | | $15.83 | $21.73 | $29.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.48 / $40.00 / $80.00
| Professional | | $30.48 | $40.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.00 / $29.26 / $46.07
| Professional | | $24.00 | $29.26 | $46.07 |