- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.03 / $55.63 / $55.63
| Facility | | $45.03 | $55.63 | $55.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.06 / $46.44 / $57.94
| Professional | | $40.06 | $46.44 | $57.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.45 / $52.49 / $81.00
| Professional | | $41.45 | $52.49 | $81.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.34 / $54.34 / $54.34
| Professional | | $54.34 | $54.34 | $54.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.70 / $64.42 / $124.61
| Facility | | $44.70 | $64.42 | $124.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.84 / $314.82 / $314.82
| Professional | | $44.84 | $314.82 | $314.82 |