- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.38 / $30.04 / $40.77
| Professional | | $14.38 | $30.04 | $40.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.47 / $38.46 / $40.49
| Professional | | $33.47 | $38.46 | $40.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.02 / $65.19 / $104.88
| Professional | | $36.02 | $65.19 | $104.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.41 / $21.65 / $29.15
| Facility | | $18.41 | $21.65 | $29.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.75 / $57.86 / $101.84
| Professional | | $32.75 | $57.86 | $101.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.00 / $41.60 / $50.82
| Professional | | $21.00 | $41.60 | $50.82 |