- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.32 / $20.54 / $22.15
| Professional | | $16.32 | $20.54 | $22.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.80 / $71.33 / $84.45
| Facility | | $52.80 | $71.33 | $84.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.72 / $26.73 / $33.78
| Professional | | $22.72 | $26.73 | $33.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $21.38
| Facility | | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.61 / $21.38 / $21.38
| Professional | | $15.61 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.84 / $18.64 / $31.06
| Professional | | $12.84 | $18.64 | $31.06 |