- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $203.03 / $264.60 / $286.50
| Facility | | $203.03 | $264.60 | $286.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.49 / $8.52 / $10.46
| Professional | | $7.49 | $8.52 | $10.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.38 / $13.14 / $30.60
| Professional | | $10.38 | $13.14 | $30.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.11 / $7.99 / $14.92
| Facility | | $6.11 | $7.99 | $14.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.11 / $12.26 / $40.40
| Professional | | $6.11 | $12.26 | $40.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.53 / $14.41 / $17.30
| Professional | | $11.53 | $14.41 | $17.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.19 / $6.75 / $10.49
| Professional | | $5.19 | $6.75 | $10.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.50 / $5.77 / $11.32
| Professional | | $4.50 | $5.77 | $11.32 |