- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.62 / $29.30 / $45.74
| Professional | | $20.62 | $29.30 | $45.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.74 / $23.74 / $26.11
| Facility | | $23.74 | $23.74 | $26.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.23 / $26.22 / $38.14
| Professional | | $18.23 | $26.22 | $38.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.11 / $34.43 / $61.80
| Professional | | $20.11 | $34.43 | $61.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.71 / $37.11 / $64.62
| Facility | | $21.71 | $37.11 | $64.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.20 / $41.40 / $247.97
| Professional | | $34.20 | $41.40 | $247.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.47 / $37.76 / $53.38
| Professional | | $33.47 | $37.76 | $53.38 |