- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.48 / $29.48 / $46.11
| Professional | | $29.48 | $29.48 | $46.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.42 / $51.42 / $51.42
| Facility | | $51.42 | $51.42 | $51.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.42 / $51.42 / $51.42
| Professional | | $51.42 | $51.42 | $51.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.33 / $36.33 / $57.04
| Facility | | $36.33 | $36.33 | $57.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.52 / $26.52 / $46.27
| Professional | | $26.52 | $26.52 | $46.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.53 / $23.01 / $23.01
| Facility | | $17.53 | $23.01 | $23.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.98 / $23.21 / $25.77
| Professional | | $20.98 | $23.21 | $25.77 |