- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $36.31 / $46.77
| Professional | | $21.88 | $36.31 | $46.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.69 / $44.67 / $53.70
| Professional | | $41.69 | $44.67 | $53.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.31 / $40.74 / $58.88
| Facility | | $36.31 | $40.74 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.67 / $56.23 / $245.47
| Professional | | $34.67 | $56.23 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $47.86 / $79.43
| Professional | | $33.88 | $47.86 | $79.43 |