- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.73 / $32.61 / $34.65
| Professional | | $27.73 | $32.61 | $34.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.41 / $25.73 / $42.22
| Facility | | $3.41 | $25.73 | $42.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.68 / $27.70 / $43.67
| Professional | | $3.68 | $27.70 | $43.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.44 / $24.44 / $61.84
| Facility | | $24.44 | $24.44 | $61.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.44 / $24.44 / $42.61
| Professional | | $24.44 | $24.44 | $42.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.51 / $31.47 / $46.01
| Professional | | $21.51 | $31.47 | $46.01 |