- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.35 / $52.53 / $61.80
| Facility | | $46.35 | $52.53 | $61.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.31 / $38.63 / $58.71
| Professional | | $24.31 | $38.63 | $58.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.00 / $43.00 / $43.00
| Professional | | $43.00 | $43.00 | $43.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.00 / $40.00 / $70.00
| Professional | | $23.00 | $40.00 | $70.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.53 / $32.34 / $32.34
| Professional | | $31.53 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.36 / $40.00 / $59.69
| Professional | | $29.36 | $40.00 | $59.69 |