- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.67 / $108.81 / $320.83
| Facility | | $52.67 | $108.81 | $320.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.06 / $7.54 / $9.52
| Professional | | $6.06 | $7.54 | $9.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.39 / $7.60 / $23.82
| Facility | | $7.39 | $7.60 | $23.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.45 / $9.91 / $12.39
| Professional | | $5.45 | $9.91 | $12.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.65 / $9.94 / $38.92
| Facility | | $8.65 | $9.94 | $38.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.62 / $7.05 / $9.98
| Professional | | $6.62 | $7.05 | $9.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.63 / $5.11 / $5.19
| Professional | | $3.63 | $5.11 | $5.19 |