- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.32 / $23.87 / $34.56
| Professional | | $23.32 | $23.87 | $34.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.37 / $272.66 / $581.72
| Facility | | $245.37 | $272.66 | $581.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.28 / $17.28 / $17.28
| Professional | | $17.28 | $17.28 | $17.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.70 / $124.18 / $180.60
| Facility | | $2.70 | $124.18 | $180.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.23 / $33.14 / $107.36
| Professional | | $14.23 | $33.14 | $107.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.96 / $32.96 / $92.52
| Professional | | $32.96 | $32.96 | $92.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.30 / $26.62 / $44.65
| Professional | | $16.30 | $26.62 | $44.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.50 / $21.61 / $32.63
| Professional | | $18.50 | $21.61 | $32.63 |