- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.02 / $449.18 / $2,224.56
| Facility | | $22.02 | $449.18 | $2,224.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.03 / $18.37 / $49.05
| Professional | | $9.03 | $18.37 | $49.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.38 / $10.84 / $13.12
| Professional | | $10.38 | $10.84 | $13.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.76 / $18.21 / $31.54
| Professional | | $8.76 | $18.21 | $31.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.45 / $24.05 / $39.86
| Professional | | $15.45 | $24.05 | $39.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.59 / $20.54 / $34.47
| Professional | | $15.59 | $20.54 | $34.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.73 / $13.73 / $26.55
| Professional | | $13.73 | $13.73 | $26.55 |