- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.50 / $34.50 / $36.56
| Facility | | $34.50 | $34.50 | $36.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.22 / $32.07 / $42.60
| Professional | | $26.22 | $32.07 | $42.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.78 / $57.47 / $70.50
| Facility | | $52.78 | $57.47 | $70.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.17 / $43.47 / $44.58
| Professional | | $35.17 | $43.47 | $44.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.56 / $35.56 / $46.67
| Facility | | $35.56 | $35.56 | $46.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.23 / $35.56 / $56.98
| Professional | | $30.23 | $35.56 | $56.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.77 / $28.01 / $43.49
| Professional | | $19.77 | $28.01 | $43.49 |