- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $48.74 / $48.74
| Professional | | $31.62 | $48.74 | $48.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.36 / $83.38 / $154.56
| Facility | | $64.36 | $83.38 | $154.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.13 / $36.86 / $54.33
| Professional | | $35.13 | $36.86 | $54.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.36 / $37.36 / $53.18
| Facility | | $37.36 | $37.36 | $53.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.27 / $27.27 / $37.36
| Professional | | $27.27 | $27.27 | $37.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.59 / $58.59 / $58.59
| Professional | | $58.59 | $58.59 | $58.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.75 / $48.74 / $48.74
| Professional | | $40.75 | $48.74 | $48.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.07 / $37.88 / $83.03
| Professional | | $24.07 | $37.88 | $83.03 |