- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.67 / $82.66 / $832.50
| Facility | | $31.67 | $82.66 | $832.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.30 / $77.18 / $216.48
| Professional | | $9.30 | $77.18 | $216.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.87 / $9.25 / $10.99
| Professional | | $7.87 | $9.25 | $10.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.78 / $5.84 / $7.34
| Professional | | $5.78 | $5.84 | $7.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.71 / $17.52 / $35.52
| Facility | | $3.71 | $17.52 | $35.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.59 / $6.26 / $8.86
| Professional | | $2.59 | $6.26 | $8.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.19 / $3.35 / $8.21
| Professional | | $2.19 | $3.35 | $8.21 |