- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $16.98 / $26.92
| Professional | | $14.13 | $16.98 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $269.15 / $288.40
| Facility | | $123.03 | $269.15 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $21.38
| Professional | | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.51 / $29.51 / $29.51
| Facility | | $29.51 | $29.51 | $29.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.02 / $20.42 / $27.54
| Professional | | $12.02 | $20.42 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $17.78 / $17.78
| Facility | | $17.78 | $17.78 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.17 / $6.17 / $6.17
| Facility | | $6.17 | $6.17 | $6.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $13.80 / $46.77
| Professional | | $7.41 | $13.80 | $46.77 |