- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.60 / $140.22 / $505.20
| Facility | | $19.60 | $140.22 | $505.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.53 / $12.30 / $13.68
| Professional | | $10.53 | $12.30 | $13.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.46 / $39.54 / $62.65
| Facility | | $14.46 | $39.54 | $62.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.74 / $5.74 / $11.33
| Professional | | $5.74 | $5.74 | $11.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.00 / $13.07 / $35.20
| Facility | | $8.00 | $13.07 | $35.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.36 / $12.50 / $19.62
| Professional | | $8.36 | $12.50 | $19.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.40 / $16.42 / $26.92
| Facility | | $10.40 | $16.42 | $26.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.17 / $17.78 / $50.48
| Professional | | $9.17 | $17.78 | $50.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.75 / $8.02 / $10.11
| Professional | | $5.75 | $8.02 | $10.11 |