- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.48 / $116.75 / $157.32
| Facility | | $42.48 | $116.75 | $157.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.48 / $42.48 / $42.48
| Professional | | $42.48 | $42.48 | $42.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.40 / $65.27 / $110.37
| Professional | | $41.40 | $65.27 | $110.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.07 / $40.07 / $42.48
| Facility | | $40.07 | $40.07 | $42.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.11 / $36.11 / $42.48
| Professional | | $36.11 | $36.11 | $42.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.65 / $42.48 / $68.84
| Professional | | $38.65 | $42.48 | $68.84 |