- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.51 / $47.66 / $48.31
| Professional | | $42.51 | $47.66 | $48.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.38 / $51.53 / $70.08
| Professional | | $46.38 | $51.53 | $70.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.93 / $73.93 / $92.41
| Professional | | $73.93 | $73.93 | $92.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.41 / $80.51 / $96.62
| Professional | | $64.41 | $80.51 | $96.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.05 / $27.05 / $27.05
| Facility | | $27.05 | $27.05 | $27.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.05 / $32.21 / $58.61
| Professional | | $27.05 | $32.21 | $58.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.64 / $11.94 / $14.93
| Professional | | $11.64 | $11.94 | $14.93 |