- 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
- $25.52 / $30.02 / $48.64
| Professional | | $25.52 | $30.02 | $48.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.65 / $31.65 / $31.65
| Facility | | $31.65 | $31.65 | $31.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.10 / $31.65 / $31.65
| Professional | | $23.10 | $31.65 | $31.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.04 / $25.04 / $25.04
| Facility | | $25.04 | $25.04 | $25.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.42 / $29.48 / $46.01
| Professional | | $21.42 | $29.48 | $46.01 |