- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.35 / $49.35 / $57.26
| Facility | | $49.35 | $49.35 | $57.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.02 / $52.39 / $60.82
| Professional | | $47.02 | $52.39 | $60.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.04 / $53.73 / $62.32
| Professional | | $51.04 | $53.73 | $62.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.46 / $59.20 / $131.83
| Professional | | $43.46 | $59.20 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.74 / $52.61 / $135.93
| Professional | | $42.74 | $52.61 | $135.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.41 / $124.25 / $143.49
| Professional | | $55.41 | $124.25 | $143.49 |