- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.57 / $44.00 / $50.14
| Professional | | $33.57 | $44.00 | $50.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.88 / $58.57 / $58.57
| Professional | | $53.88 | $58.57 | $58.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.36 / $40.36 / $60.50
| Facility | | $40.36 | $40.36 | $60.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.31 / $40.36 / $71.63
| Professional | | $34.31 | $40.36 | $71.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.38 / $31.91 / $48.39
| Professional | | $20.38 | $31.91 | $48.39 |