- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.34 / $42.13 / $43.61
| Facility | | $36.34 | $42.13 | $43.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.34 / $38.89 / $105.84
| Professional | | $36.34 | $38.89 | $105.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.28 / $35.63 / $53.42
| Professional | | $35.28 | $35.63 | $53.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.86 / $14.86 / $14.86
| Professional | | $14.86 | $14.86 | $14.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.11 / $27.62 / $35.15
| Professional | | $25.11 | $27.62 | $35.15 |