- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.26 / $28.21 / $29.33
| Professional | | $24.26 | $28.21 | $29.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.01 / $26.80 / $35.72
| Facility | | $3.01 | $26.80 | $35.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.11 / $24.11 / $32.33
| Professional | | $3.11 | $24.11 | $32.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.37 / $28.37 / $54.12
| Facility | | $28.37 | $28.37 | $54.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.37 / $28.37 / $210.92
| Professional | | $28.37 | $28.37 | $210.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.23 / $22.28 / $34.71
| Professional | | $16.23 | $22.28 | $34.71 |