- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.73 / $51.28 / $135.08
| Facility | | $25.73 | $51.28 | $135.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.24 / $17.72 / $23.16
| Professional | | $15.24 | $17.72 | $23.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.37 / $17.87 / $56.00
| Facility | | $17.37 | $17.87 | $56.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.78 / $23.54 / $29.43
| Professional | | $12.78 | $23.54 | $29.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.32 / $23.37 / $91.45
| Facility | | $20.32 | $23.37 | $91.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.55 / $16.55 / $23.54
| Professional | | $15.55 | $16.55 | $23.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.52 / $12.01 / $12.19
| Professional | | $8.52 | $12.01 | $12.19 |