- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.70 / $43.65 / $107.15
| Professional | | $25.70 | $43.65 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $37.15
| Professional | | $30.20 | $30.20 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.54 / $50.12 / $63.10
| Professional | | $27.54 | $50.12 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $24.55 / $72.44
| Professional | | $16.22 | $24.55 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.30 / $42.66 / $69.18
| Facility | | $26.30 | $42.66 | $69.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $37.15 / $89.13
| Professional | | $20.42 | $37.15 | $89.13 |