- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.67 / $30.14 / $33.47
| Professional | | $24.67 | $30.14 | $33.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $79.81 / $107.80 / $127.63
| Facility | | $79.81 | $107.80 | $127.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.34 / $36.86 / $51.05
| Professional | | $31.34 | $36.86 | $51.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.65 / $34.77 / $34.77
| Facility | | $32.65 | $34.77 | $34.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.38 / $25.38 / $25.38
| Professional | | $25.38 | $25.38 | $25.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.05 / $32.24 / $46.94
| Professional | | $22.05 | $32.24 | $46.94 |