- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.28 / $44.52 / $44.52
| Professional | | $37.28 | $44.52 | $44.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.50 / $62.12 / $78.11
| Professional | | $61.50 | $62.12 | $78.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.28 / $43.43 / $53.16
| Facility | | $37.28 | $43.43 | $53.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.87 / $21.44 / $279.63
| Professional | | $17.87 | $21.44 | $279.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.93 / $17.87 / $35.72
| Professional | | $16.93 | $17.87 | $35.72 |