- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.81 / $205.63 / $383.98
| Facility | | $58.81 | $205.63 | $383.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.34 / $10.81 / $21.58
| Professional | | $9.34 | $10.81 | $21.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.24 / $10.54 / $33.02
| Facility | | $10.24 | $10.54 | $33.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.48 / $13.63 / $17.04
| Professional | | $7.48 | $13.63 | $17.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.98 / $13.78 / $53.95
| Facility | | $11.98 | $13.78 | $53.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.17 / $9.76 / $13.96
| Professional | | $9.17 | $9.76 | $13.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.03 / $7.09 / $7.19
| Professional | | $5.03 | $7.09 | $7.19 |