- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.41 / $331.52 / $893.16
| Facility | | $20.41 | $331.52 | $893.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.84 / $9.36 / $18.00
| Professional | | $7.84 | $9.36 | $18.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.91 / $29.82 / $47.27
| Facility | | $10.91 | $29.82 | $47.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.34 / $10.32 / $10.32
| Professional | | $5.34 | $10.32 | $10.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6.04 / $9.86 / $26.57
| Facility | | $6.04 | $9.86 | $26.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.31 / $9.44 / $14.97
| Professional | | $6.31 | $9.44 | $14.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.84 / $12.38 / $20.34
| Facility | | $7.84 | $12.38 | $20.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.26 / $13.42 / $27.00
| Professional | | $8.26 | $13.42 | $27.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.98 / $12.98 / $12.98
| Facility | | $12.98 | $12.98 | $12.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.33 / $6.06 / $10.32
| Professional | | $4.33 | $6.06 | $10.32 |