- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.85 / $42.60 / $45.06
| Professional | | $34.85 | $42.60 | $45.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.98 / $68.64 / $127.24
| Facility | | $52.98 | $68.64 | $127.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.72 / $38.72 / $41.81
| Professional | | $38.72 | $38.72 | $41.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.13 / $40.36 / $40.36
| Facility | | $17.13 | $40.36 | $40.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.31 / $34.31 / $40.36
| Professional | | $34.31 | $34.31 | $40.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.85 / $35.93 / $45.06
| Professional | | $34.85 | $35.93 | $45.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.28 / $38.72 / $94.54
| Professional | | $21.28 | $38.72 | $94.54 |