- 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
- $30.23 / $31.76 / $32.83
| Professional | | $30.23 | $31.76 | $32.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.64 / $25.64 / $25.64
| Facility | | $25.64 | $25.64 | $25.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.72 / $25.64 / $25.64
| Professional | | $18.72 | $25.64 | $25.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.84 / $18.64 / $31.06
| Professional | | $12.84 | $18.64 | $31.06 |