- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.21 / $76.76 / $105.28
| Facility | | $57.21 | $76.76 | $105.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.84 / $11.10 / $56.00
| Professional | | $10.84 | $11.10 | $56.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.76 / $103.05 / $177.82
| Facility | | $29.76 | $103.05 | $177.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.14 / $13.52 / $15.55
| Professional | | $10.14 | $13.52 | $15.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.74 / $10.74 / $10.74
| Facility | | $10.74 | $10.74 | $10.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.48 / $19.00 / $23.75
| Professional | | $7.48 | $19.00 | $23.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.09 / $19.84 / $19.84
| Professional | | $9.09 | $19.84 | $19.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.68 / $16.76 / $23.46
| Facility | | $10.68 | $16.76 | $23.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.74 / $16.53 / $22.69
| Professional | | $12.74 | $16.53 | $22.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.82 / $10.19 / $16.53
| Professional | | $9.82 | $10.19 | $16.53 |