- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.73 / $129.38 / $268.62
| Facility | | $27.73 | $129.38 | $268.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.73 / $29.60 / $44.33
| Professional | | $27.73 | $29.60 | $44.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.75 / $32.75 / $177.01
| Professional | | $32.75 | $32.75 | $177.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.89 / $54.81 / $122.29
| Professional | | $30.89 | $54.81 | $122.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.04 / $30.89 / $64.62
| Professional | | $27.04 | $30.89 | $64.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.80 / $43.64 / $84.35
| Professional | | $26.80 | $43.64 | $84.35 |