- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.42 / $51.32 / $72.94
| Facility | | $50.42 | $51.32 | $72.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.69 / $36.51 / $51.32
| Professional | | $32.69 | $36.51 | $51.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.81 / $52.87 / $68.29
| Professional | | $37.81 | $52.87 | $68.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.78 / $47.09 / $77.47
| Professional | | $45.78 | $47.09 | $77.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.84 / $39.64 / $49.81
| Professional | | $33.84 | $39.64 | $49.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.22 / $55.00 / $78.13
| Professional | | $39.22 | $55.00 | $78.13 |