- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.62 / $34.57 / $83.32
| Facility | | $26.62 | $34.57 | $83.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.09 / $34.13 / $45.29
| Professional | | $25.09 | $34.13 | $45.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.97 / $52.97 / $52.97
| Professional | | $52.97 | $52.97 | $52.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.07 / $48.82 / $48.82
| Professional | | $45.07 | $48.82 | $48.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.73 / $37.47 / $54.69
| Professional | | $27.73 | $37.47 | $54.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.32 / $38.96 / $53.22
| Professional | | $34.32 | $38.96 | $53.22 |