- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.71 / $18.59 / $64.62
| Professional | | $13.71 | $18.59 | $64.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.07 / $26.60 / $32.21
| Facility | | $20.07 | $26.60 | $32.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.14 / $56.59 / $66.58
| Professional | | $29.14 | $56.59 | $66.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.03 / $37.03 / $37.03
| Facility | | $37.03 | $37.03 | $37.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.44 / $40.56 / $146.58
| Professional | | $21.44 | $40.56 | $146.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.68 / $25.01 / $45.90
| Professional | | $19.68 | $25.01 | $45.90 |