- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $36.31 / $50.12
| Professional | | $28.84 | $36.31 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $39.81 / $56.23
| Professional | | $33.88 | $39.81 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $39.81 / $47.86
| Professional | | $33.88 | $39.81 | $47.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.70 / $28.84 / $28.84
| Facility | | $25.70 | $28.84 | $28.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $36.31 / $37.15
| Facility | | $36.31 | $36.31 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $38.90 / $56.23
| Professional | | $26.92 | $38.90 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.44 / $32.36 / $48.98
| Professional | | $23.44 | $32.36 | $48.98 |