- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.50 / $125.09 / $152.38
| Facility | | $105.50 | $125.09 | $152.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.41 / $9.80 / $13.59
| Professional | | $9.41 | $9.80 | $13.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.46 / $11.76 / $13.41
| Professional | | $10.46 | $11.76 | $13.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.03 / $8.65 / $32.19
| Professional | | $7.03 | $8.65 | $32.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.07 / $16.34 / $20.94
| Professional | | $13.07 | $16.34 | $20.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.84 / $9.27 / $19.61
| Professional | | $7.84 | $9.27 | $19.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.54 / $10.39 / $10.39
| Professional | | $6.54 | $10.39 | $10.39 |