- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $34.70 / $42.92
| Professional | | $31.62 | $34.70 | $42.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.32 / $138.16 / $163.58
| Facility | | $102.32 | $138.16 | $163.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.18 / $47.27 / $65.43
| Professional | | $40.18 | $47.27 | $65.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.36 / $37.36 / $41.85
| Facility | | $37.36 | $37.36 | $41.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.27 / $37.36 / $37.36
| Professional | | $27.27 | $37.36 | $37.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.63 / $40.69 / $60.17
| Professional | | $32.63 | $40.69 | $60.17 |