- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.36 / $16.43 / $23.20
| Professional | | $10.36 | $16.43 | $23.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.25 / $20.64 / $33.15
| Professional | | $12.25 | $20.64 | $33.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.64 / $21.76 / $32.65
| Professional | | $12.64 | $21.76 | $32.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.63 / $20.49 / $35.39
| Facility | | $10.63 | $20.49 | $35.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $26.90 / $250.96
| Professional | | $20.00 | $26.90 | $250.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.22 / $24.07 / $33.35
| Professional | | $19.22 | $24.07 | $33.35 |