- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.46 / $33.77 / $33.77
| Professional | | $25.46 | $33.77 | $33.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.05 / $316.62 / $343.97
| Facility | | $150.05 | $316.62 | $343.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.39 / $32.39 / $333.50
| Facility | | $32.39 | $32.39 | $333.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.38 / $22.30 / $30.58
| Professional | | $13.38 | $22.30 | $30.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.39 / $32.39 / $333.50
| Facility | | $32.39 | $32.39 | $333.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.38 / $22.30 / $30.58
| Professional | | $13.38 | $22.30 | $30.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.61 / $16.23 / $37.86
| Professional | | $11.61 | $16.23 | $37.86 |