- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $47.86 / $57.54
| Professional | | $34.67 | $47.86 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $97.72 / $117.49
| Professional | | $91.20 | $97.72 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.67 / $50.12 / $85.11
| Facility | | $44.67 | $50.12 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $24.55 / $346.74
| Professional | | $19.95 | $24.55 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $23.44 / $61.66
| Professional | | $19.95 | $23.44 | $61.66 |