- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.02 / $14.17 / $16.67
| Professional | | $10.02 | $14.17 | $16.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $10.00
| Professional | | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $14.02 / $14.02
| Professional | | $13.49 | $14.02 | $14.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.10 / $21.25 / $50.00
| Professional | | $8.10 | $21.25 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.36 / $9.46 / $14.06
| Professional | | $7.36 | $9.46 | $14.06 |