- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.01 / $37.01 / $78.88
| Facility | | $37.01 | $37.01 | $78.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.93 / $40.75 / $60.16
| Professional | | $25.93 | $40.75 | $60.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.46 / $53.63 / $99.52
| Professional | | $31.46 | $53.63 | $99.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.07 / $108.07 / $108.07
| Professional | | $108.07 | $108.07 | $108.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.19 / $46.11 / $73.41
| Professional | | $39.19 | $46.11 | $73.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.04 / $53.23 / $97.57
| Professional | | $38.04 | $53.23 | $97.57 |