- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.68 / $378.28 / $1,097.22
| Facility | | $35.68 | $378.28 | $1,097.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.83 / $27.15 / $27.15
| Professional | | $21.83 | $27.15 | $27.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.42 / $30.43 / $61.70
| Facility | | $21.42 | $30.43 | $61.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.88 / $15.84 / $29.11
| Professional | | $11.88 | $15.84 | $29.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.78 / $39.01 / $129.04
| Facility | | $12.78 | $39.01 | $129.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.88 / $28.91 / $39.75
| Professional | | $8.88 | $28.91 | $39.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.93 / $7.61 / $51.61
| Professional | | $5.93 | $7.61 | $51.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.58 / $26.03 / $70.78
| Professional | | $10.58 | $26.03 | $70.78 |