- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.77 / $42.35 / $48.40
| Professional | | $26.77 | $42.35 | $48.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.83 / $28.55 / $53.66
| Professional | | $22.83 | $28.55 | $53.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.30 / $20.80 / $20.80
| Professional | | $20.30 | $20.80 | $20.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.25 / $55.00 / $107.91
| Facility | | $41.25 | $55.00 | $107.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.02 / $28.57 / $88.10
| Professional | | $18.02 | $28.57 | $88.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.93 / $26.66 / $41.25
| Professional | | $16.93 | $26.66 | $41.25 |