- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $18.20 / $33.88
| Professional | | $10.00 | $18.20 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.47 / $45.71
| Professional | | $10.00 | $10.47 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.22 / $20.42 / $53.70
| Professional | | $11.22 | $20.42 | $53.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $28.84 / $35.48
| Professional | | $24.55 | $28.84 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $20.42
| Facility | | $10.00 | $10.00 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $20.42 / $42.66
| Professional | | $10.72 | $20.42 | $42.66 |