- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.57 / $40.65 / $41.37
| Facility | | $35.57 | $40.65 | $41.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $34.22 / $2,136.00
| Professional | | $33.88 | $34.22 | $2,136.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.85 / $32.85 / $32.85
| Facility | | $32.85 | $32.85 | $32.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $33.88
| Facility | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $33.88 / $33.88
| Professional | | $33.88 | $33.88 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.72 / $35.44 / $46.18
| Professional | | $34.72 | $35.44 | $46.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.19 / $33.88 / $44.04
| Professional | | $32.19 | $33.88 | $44.04 |