- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.61 / $30.10 / $260.80
| Facility | | $26.61 | $30.10 | $260.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.58 / $26.21 / $43.01
| Professional | | $21.58 | $26.21 | $43.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.29 / $32.86 / $38.65
| Professional | | $26.29 | $32.86 | $38.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $48.17 / $60.23 / $196.26
| Facility | | $48.17 | $60.23 | $196.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.26 / $29.92 / $38.88
| Professional | | $18.26 | $29.92 | $38.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.91 / $25.62 / $43.33
| Professional | | $19.91 | $25.62 | $43.33 |