- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.09 / $46.52 / $186.85
| Facility | | $31.09 | $46.52 | $186.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.08 / $31.39 / $37.79
| Professional | | $31.08 | $31.39 | $37.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.02 / $33.22 / $64.68
| Facility | | $21.02 | $33.22 | $64.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.41 / $20.41 / $20.89
| Professional | | $20.41 | $20.41 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.05 / $20.41 / $20.41
| Facility | | $18.05 | $20.41 | $20.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.41 / $20.41 / $20.41
| Professional | | $20.41 | $20.41 | $20.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.68 / $34.68 / $43.52
| Professional | | $34.68 | $34.68 | $43.52 |