- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.86 / $33.86 / $37.26
| Facility | | $33.86 | $33.86 | $37.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.43 / $64.43 / $76.93
| Professional | | $64.43 | $64.43 | $76.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.83 / $34.54 / $53.19
| Facility | | $27.83 | $34.54 | $53.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.16 / $33.65 / $231.03
| Professional | | $28.16 | $33.65 | $231.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.05 / $32.67 / $54.34
| Professional | | $28.05 | $32.67 | $54.34 |