- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.36 / $109.93 / $123.87
| Facility | | $37.36 | $109.93 | $123.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.36 / $37.36 / $44.01
| Professional | | $37.36 | $37.36 | $44.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.70 / $40.68 / $41.27
| Professional | | $33.70 | $40.68 | $41.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.61 / $34.96 / $43.96
| Professional | | $34.61 | $34.96 | $43.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.65 / $36.36 / $61.83
| Facility | | $28.65 | $36.36 | $61.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.33 / $46.48 / $49.16
| Professional | | $42.33 | $46.48 | $49.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.25 / $46.48 / $47.74
| Professional | | $42.25 | $46.48 | $47.74 |