- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.60 / $206.72 / $520.20
| Facility | | $30.60 | $206.72 | $520.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.24 / $54.12 / $127.71
| Professional | | $6.24 | $54.12 | $127.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.39 / $34.56 / $56.11
| Facility | | $9.39 | $34.56 | $56.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.20 / $4.26 / $4.91
| Professional | | $3.20 | $4.26 | $4.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.39 / $3.39 / $3.39
| Facility | | $3.39 | $3.39 | $3.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.27 / $5.78 / $9.86
| Professional | | $3.27 | $5.78 | $9.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.87 / $2.87 / $2.87
| Professional | | $2.87 | $2.87 | $2.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.98 / $6.26 / $10.22
| Facility | | $3.98 | $6.26 | $10.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.22 / $5.22 / $9.86
| Professional | | $5.22 | $5.22 | $9.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.19 / $3.13 / $3.50
| Professional | | $2.19 | $3.13 | $3.50 |