- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.23 / $20.01 / $100.55
| Professional | | $16.23 | $20.01 | $100.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.92 / $34.31 / $60.24
| Facility | | $28.92 | $34.31 | $60.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.02 / $31.55 / $75.88
| Professional | | $19.02 | $31.55 | $75.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.01 / $28.92 / $58.19
| Facility | | $17.01 | $28.92 | $58.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.01 / $33.92 / $51.52
| Professional | | $20.01 | $33.92 | $51.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.95 / $32.50 / $54.88
| Professional | | $26.95 | $32.50 | $54.88 |