- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.73 / $22.38 / $23.05
| Professional | | $19.73 | $22.38 | $23.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.38 / $27.47 / $32.47
| Professional | | $23.38 | $27.47 | $32.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.57 / $30.57 / $30.57
| Facility | | $30.57 | $30.57 | $30.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.97 / $31.34 / $55.78
| Professional | | $15.97 | $31.34 | $55.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.87 / $28.87 / $28.87
| Professional | | $28.87 | $28.87 | $28.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.97 / $18.94 / $31.56
| Professional | | $14.97 | $18.94 | $31.56 |