- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.78 / $33.78 / $47.10
| Facility | | $33.78 | $33.78 | $47.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.82 / $39.27 / $47.20
| Professional | | $32.82 | $39.27 | $47.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.40 / $36.22 / $50.66
| Professional | | $34.40 | $36.22 | $50.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.27 / $45.73 / $108.43
| Professional | | $30.27 | $45.73 | $108.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.19 / $42.77 / $107.96
| Professional | | $30.19 | $42.77 | $107.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.20 / $84.33 / $114.78
| Professional | | $45.20 | $84.33 | $114.78 |