- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.87 / $274.02 / $641.29
| Facility | | $22.87 | $274.02 | $641.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.73 / $16.37 / $27.73
| Professional | | $15.73 | $16.37 | $27.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.61 / $21.19 / $66.43
| Facility | | $20.61 | $21.19 | $66.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.38 / $28.08 / $35.11
| Professional | | $11.38 | $28.08 | $35.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.11 / $27.73 / $97.65
| Facility | | $24.11 | $27.73 | $97.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.46 / $19.54 / $27.93
| Professional | | $18.46 | $19.54 | $27.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.13 / $10.13 / $14.47
| Professional | | $10.13 | $10.13 | $14.47 |