- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.67 / $44.62 / $100.65
| Facility | | $31.67 | $44.62 | $100.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.67 / $32.69 / $63.01
| Professional | | $31.67 | $32.69 | $63.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.67 / $49.16 / $100.69
| Facility | | $31.67 | $49.16 | $100.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.47 / $28.47 / $33.50
| Professional | | $28.47 | $28.47 | $33.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.76 / $32.76 / $32.76
| Facility | | $32.76 | $32.76 | $32.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.76 / $32.76 / $32.76
| Professional | | $32.76 | $32.76 | $32.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.26 / $33.06 / $35.11
| Professional | | $29.26 | $33.06 | $35.11 |