- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.74 / $32.25 / $35.65
| Professional | | $29.74 | $32.25 | $35.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.63 / $48.28 / $49.05
| Professional | | $38.63 | $48.28 | $49.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.74 / $43.26 / $75.43
| Facility | | $29.74 | $43.26 | $75.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.04 / $47.09 / $207.28
| Professional | | $24.04 | $47.09 | $207.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.09 / $52.57 / $78.51
| Facility | | $41.09 | $52.57 | $78.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.58 / $58.55 / $68.30
| Professional | | $49.58 | $58.55 | $68.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.36 / $39.54 / $55.40
| Professional | | $24.36 | $39.54 | $55.40 |