- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.26 / $50.76 / $163.90
| Facility | | $36.26 | $50.76 | $163.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.28 / $36.61 / $43.53
| Professional | | $36.28 | $36.61 | $43.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.35 / $28.56 / $39.38
| Facility | | $24.35 | $28.56 | $39.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.38 / $39.38 / $40.17
| Professional | | $39.38 | $39.38 | $40.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.22 / $34.22 / $36.28
| Facility | | $34.22 | $34.22 | $36.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.28 / $36.28 / $36.28
| Professional | | $36.28 | $36.28 | $36.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.65 / $36.28 / $41.76
| Professional | | $32.65 | $36.28 | $41.76 |