- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.76 / $30.87 / $143.57
| Facility | | $14.76 | $30.87 | $143.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.76 / $18.28 / $23.67
| Professional | | $14.76 | $18.28 | $23.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.54 / $55.57 / $115.02
| Facility | | $24.54 | $55.57 | $115.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.59 / $30.62 / $32.88
| Professional | | $22.59 | $30.62 | $32.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.57 / $1,165.00 / $13,785.00
| Facility | | $17.57 | $1,165.00 | $13,785.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.42 / $15.06 / $28.55
| Professional | | $10.42 | $15.06 | $28.55 |