- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.71 / $42.36 / $45.84
| Professional | | $23.71 | $42.36 | $45.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.82 / $53.82 / $53.82
| Facility | | $53.82 | $53.82 | $53.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.13 / $56.51 / $72.66
| Professional | | $51.13 | $56.51 | $72.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.24 / $25.24 / $77.81
| Professional | | $25.24 | $25.24 | $77.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.32 / $42.36 / $53.45
| Professional | | $32.32 | $42.36 | $53.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.54 / $25.27 / $34.15
| Professional | | $20.54 | $25.27 | $34.15 |