- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $234.42 / $676.08
| Facility | | $173.78 | $234.42 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $58.88 / $83.18
| Professional | | $28.84 | $58.88 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.15 / $0.15 / $0.17
| Professional | | $0.15 | $0.15 | $0.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.14 / $0.17 / $0.17
| Facility | | $0.14 | $0.17 | $0.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.15 / $0.15 / $0.17
| Professional | | $0.15 | $0.15 | $0.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.03 / $0.03 / $0.03
| Professional | | $0.03 | $0.03 | $0.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.14 / $0.15 / $0.33
| Professional | | $0.14 | $0.15 | $0.33 |