- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.22 / $66.22 / $104.30
| Facility | | $54.22 | $66.22 | $104.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.67 / $19.80 / $20.62
| Professional | | $9.67 | $19.80 | $20.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.53 / $13.58 / $14.82
| Facility | | $11.53 | $13.58 | $14.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.03 / $9.03 / $14.09
| Professional | | $9.03 | $9.03 | $14.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $13.63 / $17.04
| Professional | | $6.46 | $13.63 | $17.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.22 / $6.92 / $16.63
| Professional | | $4.22 | $6.92 | $16.63 |