- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.01 / $37.36 / $43.96
| Facility | | $32.01 | $37.36 | $43.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.58 / $35.25 / $47.56
| Professional | | $26.58 | $35.25 | $47.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.00 / $39.00 / $49.52
| Professional | | $24.00 | $39.00 | $49.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $29.37 / $37.72
| Professional | | $23.65 | $29.37 | $37.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.02 / $43.78 / $53.64
| Professional | | $35.02 | $43.78 | $53.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.78 / $38.52 / $54.58
| Professional | | $31.78 | $38.52 | $54.58 |