- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.11 / $20.98 / $26.08
| Professional | | $13.11 | $20.98 | $26.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.81 / $26.67 / $34.08
| Professional | | $23.81 | $26.67 | $34.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.69 / $22.41 / $26.82
| Professional | | $16.69 | $22.41 | $26.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.50 / $17.50 / $17.50
| Facility | | $17.50 | $17.50 | $17.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.69 / $61.74 / $104.01
| Professional | | $14.69 | $61.74 | $104.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.77 / $21.56 / $29.13
| Professional | | $11.77 | $21.56 | $29.13 |