- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.40 / $61.40 / $77.64
| Facility | | $61.40 | $61.40 | $77.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.84 / $54.52 / $71.45
| Professional | | $43.84 | $54.52 | $71.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.51 / $56.51 / $71.40
| Professional | | $56.51 | $56.51 | $71.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.46 / $70.78 / $125.23
| Professional | | $45.46 | $70.78 | $125.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.16 / $66.43 / $104.28
| Professional | | $45.16 | $66.43 | $104.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.28 / $76.19 / $131.53
| Professional | | $52.28 | $76.19 | $131.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.32 / $79.95 / $100.23
| Professional | | $56.32 | $79.95 | $100.23 |