- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.71 / $50.93 / $165.04
| Facility | | $28.71 | $50.93 | $165.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.71 / $37.18 / $161.04
| Professional | | $28.71 | $37.18 | $161.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.04 / $35.27 / $90.23
| Professional | | $34.04 | $35.27 | $90.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.54 / $39.45 / $108.69
| Professional | | $26.54 | $39.45 | $108.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.31 / $45.63 / $73.65
| Professional | | $34.31 | $45.63 | $73.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.14 / $39.64 / $82.73
| Professional | | $28.14 | $39.64 | $82.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.21 / $39.46 / $49.19
| Professional | | $32.21 | $39.46 | $49.19 |