- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $62.85 / $164.74 / $341.09
| Facility | | $62.85 | $164.74 | $341.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.45 / $7.33 / $10.77
| Professional | | $6.45 | $7.33 | $10.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.03 / $8.06 / $12.92
| Professional | | $7.03 | $8.06 | $12.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.18 / $6.42 / $12.64
| Facility | | $5.18 | $6.42 | $12.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.18 / $9.27 / $14.37
| Professional | | $5.18 | $9.27 | $14.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $12.21 / $14.66
| Professional | | $9.77 | $12.21 | $14.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.40 / $5.35 / $7.91
| Professional | | $4.40 | $5.35 | $7.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.81 / $4.88 / $8.56
| Professional | | $3.81 | $4.88 | $8.56 |