- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.32 / $33.69 / $48.09
| Professional | | $30.32 | $33.69 | $48.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.58 / $27.97 / $46.62
| Facility | | $23.58 | $27.97 | $46.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.32 / $30.32 / $30.32
| Professional | | $30.32 | $30.32 | $30.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.58 / $27.97 / $46.62
| Facility | | $23.58 | $27.97 | $46.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.32 / $30.32 / $30.32
| Professional | | $30.32 | $30.32 | $30.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.32 / $32.14 / $46.64
| Professional | | $30.32 | $32.14 | $46.64 |