- 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
- $18.91 / $55.52 / $71.68
| Facility | | $18.91 | $55.52 | $71.68 |
- 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 / $30.03 / $50.65
| Professional | | $12.86 | $30.03 | $50.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.87 / $22.09 / $52.27
| Professional | | $10.87 | $22.09 | $52.27 |