- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.73 / $20.21 / $69.33
| Professional | | $16.73 | $20.21 | $69.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.72 / $46.54 / $76.68
| Facility | | $11.72 | $46.54 | $76.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.52 / $22.03 / $23.96
| Professional | | $16.52 | $22.03 | $23.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.64 / $19.64 / $19.64
| Professional | | $19.64 | $19.64 | $19.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.43 / $23.48 / $40.72
| Facility | | $18.43 | $23.48 | $40.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.96 / $21.14 / $114.85
| Professional | | $16.96 | $21.14 | $114.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.52 / $20.05 / $36.04
| Professional | | $16.52 | $20.05 | $36.04 |