- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.09 / $43.23 / $51.33
| Professional | | $22.09 | $43.23 | $51.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.65 / $52.28 / $64.31
| Professional | | $40.65 | $52.28 | $64.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.65 / $25.65 / $25.65
| Professional | | $25.65 | $25.65 | $25.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.71 / $44.04 / $62.39
| Facility | | $35.71 | $44.04 | $62.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.22 / $26.07 / $30.12
| Professional | | $22.22 | $26.07 | $30.12 |