- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.47 / $32.47 / $57.65
| Facility | | $32.47 | $32.47 | $57.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.47 / $34.11 / $54.64
| Professional | | $32.47 | $34.11 | $54.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.77 / $77.36 / $84.81
| Professional | | $41.77 | $77.36 | $84.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.24 / $62.80 / $86.44
| Professional | | $50.24 | $62.80 | $86.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.47 / $48.05 / $105.31
| Facility | | $32.47 | $48.05 | $105.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.28 / $64.94 / $81.37
| Professional | | $39.28 | $64.94 | $81.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.28 / $63.38 / $81.37
| Professional | | $39.28 | $63.38 | $81.37 |