- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.02 / $35.02 / $148.46
| Facility | | $35.02 | $35.02 | $148.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.06 / $38.07 / $48.33
| Professional | | $34.06 | $38.07 | $48.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.41 / $44.41 / $51.07
| Professional | | $44.41 | $44.41 | $51.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.22 / $48.88 / $108.73
| Professional | | $32.22 | $48.88 | $108.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.58 / $50.02 / $83.18
| Professional | | $39.58 | $50.02 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.90 / $41.59 / $98.42
| Professional | | $32.90 | $41.59 | $98.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.33 / $47.91 / $59.11
| Professional | | $33.33 | $47.91 | $59.11 |