- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.63 / $43.78 / $51.50
| Facility | | $38.63 | $43.78 | $51.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.87 / $33.50 / $55.72
| Professional | | $22.87 | $33.50 | $55.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.00 / $37.00 / $64.88
| Professional | | $25.00 | $37.00 | $64.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.84 / $32.34 / $43.66
| Professional | | $24.84 | $32.34 | $43.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.79 / $37.36 / $50.02
| Professional | | $25.79 | $37.36 | $50.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.36 / $37.40 / $51.74
| Professional | | $29.36 | $37.40 | $51.74 |