- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.08 / $130.08 / $886.80
| Facility | | $130.08 | $130.08 | $886.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.47 / $2.49 / $4.59
| Professional | | $1.47 | $2.49 | $4.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.73 / $1.73 / $1.73
| Professional | | $1.73 | $1.73 | $1.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.92 / $2.91 / $4.83
| Facility | | $1.92 | $2.91 | $4.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.22 / $3.22 / $3.39
| Professional | | $3.22 | $3.22 | $3.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $5.93 / $6.61
| Professional | | $5.25 | $5.93 | $6.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.37 / $2.37 / $3.56
| Professional | | $2.37 | $2.37 | $3.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.33 / $1.44 / $2.42
| Professional | | $1.33 | $1.44 | $2.42 |