- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.40 / $110.26 / $117.98
| Professional | | $23.40 | $110.26 | $117.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.02 / $31.02 / $40.63
| Facility | | $31.02 | $31.02 | $40.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.84 / $34.18 / $45.16
| Professional | | $20.84 | $34.18 | $45.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.57 / $25.21 / $45.29
| Facility | | $19.57 | $25.21 | $45.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $32.89 / $42.09
| Professional | | $21.38 | $32.89 | $42.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.28 / $37.76 / $40.57
| Professional | | $33.28 | $37.76 | $40.57 |