- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.18 / $30.42 / $32.82
| Professional | | $24.18 | $30.42 | $32.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.23 / $105.67 / $125.10
| Facility | | $78.23 | $105.67 | $125.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.65 / $39.60 / $50.04
| Professional | | $33.65 | $39.60 | $50.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.22 / $33.22 / $33.22
| Facility | | $33.22 | $33.22 | $33.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.25 / $33.22 / $33.22
| Professional | | $24.25 | $33.22 | $33.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.62 / $27.61 / $46.01
| Professional | | $21.62 | $27.61 | $46.01 |