- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $122.47 / $725.93
| Facility | | $12.88 | $122.47 | $725.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.82 / $23.87 / $28.25
| Professional | | $19.82 | $23.87 | $28.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.89 / $23.55 / $73.80
| Facility | | $22.89 | $23.55 | $73.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.82 / $30.98 / $38.72
| Professional | | $16.82 | $30.98 | $38.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.78 / $30.80 / $120.49
| Facility | | $26.78 | $30.80 | $120.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.50 / $21.71 / $30.72
| Professional | | $20.50 | $21.71 | $30.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.25 / $15.32 / $16.07
| Professional | | $11.25 | $15.32 | $16.07 |