- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.33 / $40.72 / $51.13
| Professional | | $28.33 | $40.72 | $51.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.63 / $45.80 / $47.77
| Professional | | $35.63 | $45.80 | $47.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.36 / $40.36 / $40.36
| Facility | | $40.36 | $40.36 | $40.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.31 / $40.36 / $48.45
| Professional | | $34.31 | $40.36 | $48.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.33 / $56.57 / $289.64
| Facility | | $28.33 | $56.57 | $289.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.47 / $34.72 / $63.54
| Professional | | $25.47 | $34.72 | $63.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.47 / $34.72 / $63.54
| Professional | | $25.47 | $34.72 | $63.54 |