- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.35 / $130.07 / $150.53
| Facility | | $28.35 | $130.07 | $150.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.75 / $65.44 / $119.73
| Professional | | $21.75 | $65.44 | $119.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.65 / $69.19 / $110.70
| Professional | | $29.65 | $69.19 | $110.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.35 / $61.01 / $72.32
| Professional | | $47.35 | $61.01 | $72.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.13 / $54.87 / $109.75
| Professional | | $26.13 | $54.87 | $109.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.40 / $105.00 / $155.41
| Professional | | $71.40 | $105.00 | $155.41 |