- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.07 / $42.74 / $50.12
| Professional | | $22.07 | $42.74 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.65 / $25.65 / $25.65
| Professional | | $25.65 | $25.65 | $25.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.07 / $46.98 / $70.98
| Facility | | $24.07 | $46.98 | $70.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.65 / $26.66 / $354.83
| Professional | | $24.65 | $26.66 | $354.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.10 / $26.66 / $38.25
| Professional | | $24.10 | $26.66 | $38.25 |