- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.32 / $46.47 / $48.09
| Professional | | $28.32 | $46.47 | $48.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.03 / $54.03 / $54.03
| Professional | | $54.03 | $54.03 | $54.03 |
- 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
- $41.61 / $46.47 / $70.98
| Facility | | $41.61 | $46.47 | $70.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.77 / $29.42 / $62.47
| Professional | | $17.77 | $29.42 | $62.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.77 / $24.44 / $38.25
| Professional | | $17.77 | $24.44 | $38.25 |