- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.62 / $133.05 / $168.14
| Facility | | $110.62 | $133.05 | $168.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.97 / $7.47 / $10.01
| Professional | | $6.97 | $7.47 | $10.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.16 / $9.16 / $12.92
| Professional | | $9.16 | $9.16 | $12.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.50 / $10.66 / $22.90
| Professional | | $7.50 | $10.66 | $22.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.94 / $8.96 / $13.08
| Professional | | $6.94 | $8.96 | $13.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.51 / $8.78 / $13.74
| Professional | | $6.51 | $8.78 | $13.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.35 / $8.96 / $11.28
| Professional | | $6.35 | $8.96 | $11.28 |