- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.43 / $35.51 / $35.51
| Professional | | $32.43 | $35.51 | $35.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.63 / $53.63 / $53.63
| Facility | | $53.63 | $53.63 | $53.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.59 / $48.27 / $54.19
| Professional | | $45.59 | $48.27 | $54.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.82 / $44.82 / $53.63
| Facility | | $44.82 | $44.82 | $53.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.94 / $45.59 / $54.19
| Professional | | $43.94 | $45.59 | $54.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.76 / $43.50 / $48.00
| Professional | | $32.76 | $43.50 | $48.00 |