- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.00 / $179.60 / $301.14
| Facility | | $37.00 | $179.60 | $301.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.22 / $12.30 / $13.48
| Professional | | $12.22 | $12.30 | $13.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.40 / $121.87 / $237.64
| Facility | | $93.40 | $121.87 | $237.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.16 / $28.32 / $30.57
| Professional | | $14.16 | $28.32 | $30.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.76 / $26.85 / $42.43
| Professional | | $13.76 | $26.85 | $42.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.54 / $103.86 / $381.42
| Facility | | $20.54 | $103.86 | $381.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.18 / $11.18 / $37.28
| Professional | | $11.18 | $11.18 | $37.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.37 / $34.09 / $111.84
| Facility | | $22.37 | $34.09 | $111.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.39 / $38.01 / $48.65
| Professional | | $22.39 | $38.01 | $48.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.62 / $11.18 / $20.50
| Professional | | $10.62 | $11.18 | $20.50 |