- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.77 / $188.94 / $408.58
| Facility | | $90.77 | $188.94 | $408.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.47 / $5.51 / $79.54
| Professional | | $2.47 | $5.51 | $79.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.13 / $4.79 / $5.51
| Facility | | $4.13 | $4.79 | $5.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.47 / $2.47 / $2.47
| Professional | | $2.47 | $2.47 | $2.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.11 / $2.93 / $4.94
| Professional | | $2.11 | $2.93 | $4.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.72 / $3.34 / $3.52
| Professional | | $2.72 | $3.34 | $3.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.47 / $2.47 / $2.47
| Professional | | $2.47 | $2.47 | $2.47 |