- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.58 / $107.20 / $170.48
| Facility | | $32.58 | $107.20 | $170.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.48 / $6.52 / $7.74
| Professional | | $5.48 | $6.52 | $7.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.25 / $6.42 / $20.14
| Facility | | $6.25 | $6.42 | $20.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.51 / $8.67 / $10.84
| Professional | | $4.51 | $8.67 | $10.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.30 / $8.40 / $32.85
| Facility | | $7.30 | $8.40 | $32.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.59 / $5.97 / $8.38
| Professional | | $5.59 | $5.97 | $8.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.07 / $4.20 / $4.38
| Professional | | $3.07 | $4.20 | $4.38 |