- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.59 / $29.44 / $40.36
| Professional | | $13.59 | $29.44 | $40.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.47 / $40.96 / $43.12
| Professional | | $32.47 | $40.96 | $43.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.00 / $63.00 / $104.57
| Professional | | $37.00 | $63.00 | $104.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.82 / $22.70 / $31.12
| Facility | | $18.82 | $22.70 | $31.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.00 / $56.59 / $101.63
| Professional | | $32.00 | $56.59 | $101.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.00 / $43.27 / $52.79
| Professional | | $25.00 | $43.27 | $52.79 |