- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.02 / $31.02 / $41.25
| Facility | | $31.02 | $31.02 | $41.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.84 / $36.96 / $47.10
| Professional | | $27.84 | $36.96 | $47.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.94 / $167.40 / $225.21
| Facility | | $137.94 | $167.40 | $225.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.67 / $33.93 / $46.48
| Professional | | $23.67 | $33.93 | $46.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.62 / $44.22 / $66.48
| Professional | | $27.62 | $44.22 | $66.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.71 / $45.48 / $65.80
| Professional | | $37.71 | $45.48 | $65.80 |