- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.84 / $173.06 / $173.06
| Facility | | $17.84 | $173.06 | $173.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.84 / $22.20 / $5,038.00
| Professional | | $18.84 | $22.20 | $5,038.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.36 / $51.34 / $57.62
| Professional | | $42.36 | $51.34 | $57.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.32 / $29.62 / $37.24
| Professional | | $29.32 | $29.62 | $37.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.84 / $38.22 / $121.47
| Facility | | $17.84 | $38.22 | $121.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.70 / $30.58 / $43.69
| Professional | | $10.70 | $30.58 | $43.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.70 / $25.99 / $43.69
| Professional | | $10.70 | $25.99 | $43.69 |