- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $47.90 / $48.32 / $76.61
| Facility | | $47.90 | $48.32 | $76.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.65 / $44.27 / $62.13
| Professional | | $36.65 | $44.27 | $62.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.66 / $56.66 / $56.66
| Professional | | $56.66 | $56.66 | $56.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.64 / $60.25 / $102.38
| Professional | | $32.64 | $60.25 | $102.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.51 / $63.65 / $83.37
| Professional | | $49.51 | $63.65 | $83.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.44 / $46.13 / $75.84
| Professional | | $36.44 | $46.13 | $75.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $50.43 / $86.56
| Professional | | $32.36 | $50.43 | $86.56 |