- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.82 / $56.78 / $486.05
| Facility | | $13.82 | $56.78 | $486.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.52 / $28.26 / $169.83
| Professional | | $11.52 | $28.26 | $169.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.77 / $13.77 / $13.77
| Professional | | $13.77 | $13.77 | $13.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.38 / $43.70 / $90.39
| Professional | | $12.38 | $43.70 | $90.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.21 / $57.27 / $81.23
| Professional | | $48.21 | $57.27 | $81.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.31 / $59.73 / $107.99
| Professional | | $40.31 | $59.73 | $107.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.90 / $56.72 / $73.83
| Professional | | $44.90 | $56.72 | $73.83 |