- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.87 / $22.45 / $24.81
| Professional | | $19.87 | $22.45 | $24.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.22 / $26.66 / $33.33
| Facility | | $22.22 | $26.66 | $33.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.60 / $51.51 / $53.56
| Professional | | $24.60 | $51.51 | $53.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.86 / $47.86 / $47.86
| Facility | | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.32 / $22.32 / $22.32
| Professional | | $22.32 | $22.32 | $22.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.01 / $30.08 / $33.09
| Professional | | $28.01 | $30.08 | $33.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.23 / $21.94 / $37.78
| Professional | | $13.23 | $21.94 | $37.78 |