- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.47 / $32.06 / $34.58
| Professional | | $25.47 | $32.06 | $34.58 |
- 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
- $47.16 / $49.55 / $51.23
| Professional | | $47.16 | $49.55 | $51.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.35 / $33.35 / $33.35
| Facility | | $33.35 | $33.35 | $33.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.35 / $24.35 / $24.35
| Professional | | $24.35 | $24.35 | $24.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $71.17 / $71.17 / $71.17
| Facility | | $71.17 | $71.17 | $71.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.77 / $29.08 / $48.46
| Professional | | $22.77 | $29.08 | $48.46 |