- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.20 / $199.53 / $794.33
| Facility | | $18.20 | $199.53 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $12.30 / $63.10
| Professional | | $9.77 | $12.30 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $11.48 / $14.13
| Professional | | $10.23 | $11.48 | $14.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $51.29 / $89.13
| Professional | | $11.48 | $51.29 | $89.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.62 / $18.62 / $18.62
| Facility | | $18.62 | $18.62 | $18.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $13.18 / $20.89
| Professional | | $10.47 | $13.18 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.77 / $11.75 / $20.42
| Facility | | $9.77 | $11.75 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $10.00 / $10.00
| Professional | | $10.00 | $10.00 | $10.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.12 / $11.22 / $16.98
| Professional | | $9.12 | $11.22 | $16.98 |