- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.64 / $277.14 / $1,027.68
| Facility | | $37.64 | $277.14 | $1,027.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.90 / $18.55 / $34.82
| Professional | | $15.90 | $18.55 | $34.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.59 / $21.18 / $66.38
| Facility | | $20.59 | $21.18 | $66.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.38 / $27.67 / $34.59
| Professional | | $11.38 | $27.67 | $34.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.09 / $27.70 / $97.56
| Facility | | $24.09 | $27.70 | $97.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.44 / $19.54 / $27.93
| Professional | | $18.44 | $19.54 | $27.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.11 / $10.67 / $14.45
| Professional | | $10.11 | $10.67 | $14.45 |