- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.25 / $26.66 / $51.63
| Professional | | $21.25 | $26.66 | $51.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.46 / $40.70 / $48.62
| Professional | | $25.46 | $40.70 | $48.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.97 / $33.97 / $33.97
| Facility | | $33.97 | $33.97 | $33.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.53 / $34.71 / $56.81
| Professional | | $29.53 | $34.71 | $56.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.25 / $31.48 / $47.76
| Facility | | $21.25 | $31.48 | $47.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.73 / $33.72 / $73.42
| Professional | | $26.73 | $33.72 | $73.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $40.71 / $63.26
| Professional | | $32.34 | $40.71 | $63.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.45 / $31.60 / $46.02
| Professional | | $25.45 | $31.60 | $46.02 |