- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.18 / $132.49 / $225.08
| Facility | | $61.18 | $132.49 | $225.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.93 / $12.84 / $14.38
| Professional | | $10.93 | $12.84 | $14.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $12.65 / $39.63
| Facility | | $12.30 | $12.65 | $39.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.03 / $16.52 / $20.65
| Professional | | $9.03 | $16.52 | $20.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.38 / $16.54 / $64.72
| Facility | | $14.38 | $16.54 | $64.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.01 / $11.67 / $16.76
| Professional | | $11.01 | $11.67 | $16.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.04 / $8.50 / $8.63
| Professional | | $6.04 | $8.50 | $8.63 |