- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.00 / $50.79 / $52.87
| Facility | | $45.00 | $50.79 | $52.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.78 / $53.32 / $72.40
| Professional | | $44.78 | $53.32 | $72.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.78 / $10.00 / $10.31
| Professional | | $8.78 | $10.00 | $10.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.21 / $54.68 / $65.20
| Facility | | $54.21 | $54.68 | $65.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.73 / $57.73 / $100.43
| Professional | | $57.73 | $57.73 | $100.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.25 / $68.93 / $108.06
| Professional | | $48.25 | $68.93 | $108.06 |