- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.63 / $54.60 / $87.35
| Professional | | $28.63 | $54.60 | $87.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.64 / $61.65 / $95.33
| Professional | | $44.64 | $61.65 | $95.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.54 / $59.00 / $123.83
| Professional | | $29.54 | $59.00 | $123.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.00 / $61.64 / $108.93
| Facility | | $35.00 | $61.64 | $108.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $137.11
| Professional | | $30.00 | $30.00 | $137.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.01 / $71.91 / $87.70
| Professional | | $57.01 | $71.91 | $87.70 |