- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.16 / $32.63 / $36.56
| Professional | | $29.16 | $32.63 | $36.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.04 / $30.28 / $43.40
| Facility | | $4.04 | $30.28 | $43.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.80 / $32.61 / $43.47
| Professional | | $3.80 | $32.61 | $43.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.65 / $36.65 / $64.59
| Facility | | $36.65 | $36.65 | $64.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.65 / $36.65 / $42.64
| Professional | | $36.65 | $36.65 | $42.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.82 / $30.45 / $46.68
| Professional | | $21.82 | $30.45 | $46.68 |