- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $21.88 / $72.44
| Professional | | $12.88 | $21.88 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $41.69 / $47.86
| Facility | | $34.67 | $41.69 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $36.31 / $43.65
| Professional | | $26.30 | $36.31 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.22 / $16.22 / $16.22
| Professional | | $16.22 | $16.22 | $16.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $38.90
| Professional | | $32.36 | $32.36 | $38.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $20.89 / $72.44
| Professional | | $12.88 | $20.89 | $72.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $32.36 / $45.71
| Professional | | $15.14 | $32.36 | $45.71 |