- 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
- $18.48 / $38.63 / $58.71
| Professional | | $18.48 | $38.63 | $58.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.92 / $25.06 / $27.03
| Professional | | $16.92 | $25.06 | $27.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.00 / $35.00 / $35.00
| Professional | | $35.00 | $35.00 | $35.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.00 / $32.27 / $55.00
| Professional | | $18.00 | $32.27 | $55.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.33 / $32.34 / $32.34
| Professional | | $24.33 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.23 / $40.00 / $53.26
| Professional | | $24.23 | $40.00 | $53.26 |