- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.84 / $21.33 / $28.92
| Professional | | $14.84 | $21.33 | $28.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.02 / $25.07 / $25.41
| Professional | | $18.02 | $25.07 | $25.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $22.61
| Facility | | $20.72 | $20.72 | $22.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.61 / $20.72 / $24.62
| Professional | | $17.61 | $20.72 | $24.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.84 / $28.77 / $148.63
| Facility | | $14.84 | $28.77 | $148.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.55 / $16.69 / $35.28
| Professional | | $12.55 | $16.69 | $35.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.36 / $16.55 / $26.83
| Professional | | $12.36 | $16.55 | $26.83 |