- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.58 / $48.18 / $61.27
| Facility | | $37.58 | $48.18 | $61.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.46 / $44.02 / $64.50
| Professional | | $25.46 | $44.02 | $64.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.41 / $65.19 / $65.19
| Professional | | $55.41 | $65.19 | $65.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.77 / $47.28 / $70.26
| Professional | | $26.77 | $47.28 | $70.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.88 / $42.70 / $58.13
| Professional | | $37.88 | $42.70 | $58.13 |