- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.06 / $37.82 / $40.81
| Professional | | $30.06 | $37.82 | $40.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.28 / $131.35 / $155.50
| Facility | | $97.28 | $131.35 | $155.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.65 / $58.46 / $60.45
| Professional | | $55.65 | $58.46 | $60.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.35 / $39.35 / $39.35
| Facility | | $39.35 | $39.35 | $39.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.73 / $39.34 / $39.35
| Professional | | $28.73 | $39.34 | $39.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.64 / $34.32 / $57.20
| Professional | | $23.64 | $34.32 | $57.20 |