- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.57 / $20.98 / $26.84
| Professional | | $18.57 | $20.98 | $26.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.38 / $200.17 / $244.64
| Facility | | $153.38 | $200.17 | $244.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.19 / $35.19 / $35.19
| Professional | | $35.19 | $35.19 | $35.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.94 / $105.37 / $107.43
| Facility | | $59.94 | $105.37 | $107.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.86 / $27.95 / $50.65
| Professional | | $12.86 | $27.95 | $50.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.87 / $21.87 / $52.27
| Professional | | $10.87 | $21.87 | $52.27 |