- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.26 / $154.33 / $463.38
| Facility | | $15.26 | $154.33 | $463.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.52 / $10.50 / $21.58
| Professional | | $9.52 | $10.50 | $21.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.30 / $10.59 / $33.19
| Facility | | $10.30 | $10.59 | $33.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.35 / $21.48 / $26.85
| Professional | | $17.35 | $21.48 | $26.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.05 / $13.86 / $54.23
| Facility | | $12.05 | $13.86 | $54.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.23 / $10.25 / $35.11
| Professional | | $9.23 | $10.25 | $35.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.05 / $5.05 / $7.23
| Professional | | $5.05 | $5.05 | $7.23 |