- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.78 / $33.22 / $40.78
| Professional | | $28.78 | $33.22 | $40.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.78 / $40.65 / $56.45
| Facility | | $35.78 | $40.65 | $56.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.24 / $35.15 / $42.12
| Facility | | $33.24 | $35.15 | $42.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.07 / $31.07 / $31.07
| Professional | | $31.07 | $31.07 | $31.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.86 / $35.02 / $55.10
| Professional | | $25.86 | $35.02 | $55.10 |