- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.57 / $38.25 / $55.34
| Facility | | $30.57 | $38.25 | $55.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.57 / $30.57 / $38.21
| Professional | | $30.57 | $30.57 | $38.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.08 / $37.08 / $37.08
| Facility | | $37.08 | $37.08 | $37.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.46 / $37.08 / $37.08
| Professional | | $35.46 | $37.08 | $37.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.85 / $33.71 / $33.71
| Facility | | $28.85 | $33.71 | $33.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.71 / $33.71 / $33.71
| Professional | | $33.71 | $33.71 | $33.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.46 / $35.97 / $38.61
| Professional | | $32.46 | $35.97 | $38.61 |