- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.06 / $146.94 / $286.17
| Facility | | $34.06 | $146.94 | $286.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.97 / $34.06 / $41.71
| Professional | | $33.97 | $34.06 | $41.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.34 / $35.34 / $108.89
| Professional | | $35.34 | $35.34 | $108.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.46 / $48.36 / $129.87
| Professional | | $35.46 | $48.36 | $129.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.40 / $43.60 / $82.12
| Professional | | $36.40 | $43.60 | $82.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.87 / $51.21 / $82.90
| Professional | | $28.87 | $51.21 | $82.90 |