- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.47 / $34.57 / $35.01
| Professional | | $25.47 | $34.57 | $35.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.41 / $111.30 / $131.77
| Facility | | $82.41 | $111.30 | $131.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $38.07 / $52.71
| Professional | | $32.36 | $38.07 | $52.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.72 / $38.57 / $38.57
| Facility | | $33.72 | $38.57 | $38.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.16 / $28.16 / $28.16
| Professional | | $28.16 | $28.16 | $28.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.82 / $28.82 / $28.82
| Facility | | $28.82 | $28.82 | $28.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.65 / $31.16 / $48.47
| Professional | | $24.65 | $31.16 | $48.47 |