- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.61 / $32.61 / $33.35
| Facility | | $32.61 | $32.61 | $33.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.17 / $34.36 / $42.40
| Professional | | $31.17 | $34.36 | $42.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.94 / $167.40 / $225.21
| Facility | | $137.94 | $167.40 | $225.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.19 / $41.35 / $51.00
| Professional | | $30.19 | $41.35 | $51.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.10 / $51.25 / $145.56
| Professional | | $30.10 | $51.25 | $145.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.87 / $40.28 / $52.97
| Professional | | $31.87 | $40.28 | $52.97 |