- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.93 / $15.83 / $25.66
| Professional | | $13.93 | $15.83 | $25.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.08 / $23.74 / $23.74
| Professional | | $22.08 | $23.74 | $23.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.75 / $28.96 / $34.15
| Professional | | $22.75 | $28.96 | $34.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.75 / $64.50 / $104.57
| Professional | | $32.75 | $64.50 | $104.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.31 / $17.73 / $23.74
| Facility | | $13.31 | $17.73 | $23.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.81 / $28.50 / $165.54
| Professional | | $22.81 | $28.50 | $165.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.66 / $25.66 / $29.94
| Professional | | $21.66 | $25.66 | $29.94 |