- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.33 / $42.88 / $50.59
| Professional | | $30.33 | $42.88 | $50.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.75 / $6.92 / $11.46
| Facility | | $1.75 | $6.92 | $11.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.88 / $2.50 / $3.13
| Professional | | $1.88 | $2.50 | $3.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.84 / $48.84 / $48.84
| Facility | | $48.84 | $48.84 | $48.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.98 / $183.98 / $183.98
| Professional | | $183.98 | $183.98 | $183.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.15 / $60.91 / $87.10
| Facility | | $32.15 | $60.91 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.40 / $54.86 / $280.19
| Professional | | $44.40 | $54.86 | $280.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.40 / $53.03 / $102.86
| Professional | | $44.40 | $53.03 | $102.86 |