- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.40 / $50.79 / $101.58
| Facility | | $25.40 | $50.79 | $101.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.40 / $40.63 / $40.63
| Professional | | $25.40 | $40.63 | $40.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $55.19 / $55.19
| Professional | | $52.48 | $55.19 | $55.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.86 / $33.86 / $42.66
| Facility | | $33.86 | $33.86 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.72 / $40.63 / $47.07
| Professional | | $35.72 | $40.63 | $47.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.22 / $14.22 / $20.32
| Professional | | $14.22 | $14.22 | $20.32 |