- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.25 / $57.76 / $100.65
| Facility | | $28.25 | $57.76 | $100.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.67 / $31.67 / $34.83
| Professional | | $31.67 | $31.67 | $34.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.03 / $43.72 / $58.82
| Facility | | $36.03 | $43.72 | $58.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.25 / $29.25 / $29.25
| Professional | | $29.25 | $29.25 | $29.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.76 / $32.76 / $32.76
| Facility | | $32.76 | $32.76 | $32.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.76 / $32.76 / $37.11
| Professional | | $32.76 | $32.76 | $37.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.26 / $33.06 / $34.95
| Professional | | $29.26 | $33.06 | $34.95 |