- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.46 / $38.46 / $40.72
| Facility | | $38.46 | $38.46 | $40.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.71 / $36.52 / $47.29
| Professional | | $30.71 | $36.52 | $47.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.65 / $61.65 / $105.19
| Facility | | $61.65 | $61.65 | $105.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.42 / $47.77 / $50.92
| Professional | | $41.42 | $47.77 | $50.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.36 / $40.36 / $43.25
| Facility | | $40.36 | $40.36 | $43.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.31 / $40.36 / $65.85
| Professional | | $34.31 | $40.36 | $65.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.94 / $31.25 / $49.45
| Professional | | $23.94 | $31.25 | $49.45 |