- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.20 / $88.41 / $131.07
| Facility | | $53.20 | $88.41 | $131.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.42 / $6.97 / $13.01
| Professional | | $6.42 | $6.97 | $13.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.43 / $17.48 / $19.63
| Professional | | $14.43 | $17.48 | $19.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.91 / $10.01 / $12.59
| Professional | | $9.91 | $10.01 | $12.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.34 / $52.30 / $87.64
| Facility | | $7.34 | $52.30 | $87.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.34 / $10.42 / $17.36
| Professional | | $4.34 | $10.42 | $17.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.65 / $6.07 / $14.89
| Professional | | $3.65 | $6.07 | $14.89 |