- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.93 / $47.93 / $52.74
| Facility | | $47.93 | $47.93 | $52.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.06 / $55.90 / $66.63
| Professional | | $29.06 | $55.90 | $66.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.13 / $53.85 / $68.79
| Professional | | $40.13 | $53.85 | $68.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.24 / $42.24 / $47.37
| Facility | | $42.24 | $42.24 | $47.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.62 / $33.81 / $102.57
| Professional | | $21.62 | $33.81 | $102.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.10 / $55.58 / $103.26
| Professional | | $32.10 | $55.58 | $103.26 |