- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.67 / $31.67 / $45.78
| Professional | | $31.67 | $31.67 | $45.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.65 / $38.47 / $100.36
| Facility | | $30.65 | $38.47 | $100.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.47 / $28.47 / $31.31
| Professional | | $28.47 | $28.47 | $31.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.76 / $32.76 / $32.76
| Facility | | $32.76 | $32.76 | $32.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.76 / $32.76 / $32.76
| Professional | | $32.76 | $32.76 | $32.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.20 / $38.40 / $58.93
| Professional | | $33.20 | $38.40 | $58.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.67 / $31.67 / $46.29
| Professional | | $31.67 | $31.67 | $46.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.26 / $29.26 / $43.89
| Professional | | $29.26 | $29.26 | $43.89 |