- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.74 / $42.66 / $102.33
| Facility | | $40.74 | $42.66 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $40.74 / $44.67
| Professional | | $39.81 | $40.74 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $43.65
| Facility | | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $43.65 / $44.67
| Professional | | $43.65 | $43.65 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.90 / $38.90 / $40.74
| Facility | | $38.90 | $38.90 | $40.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $40.74 / $40.74
| Professional | | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.74 / $40.74 / $42.66
| Facility | | $40.74 | $40.74 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $40.74 / $47.86
| Professional | | $40.74 | $40.74 | $47.86 |