- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.98 / $61.68 / $1,767.29
| Facility | | $26.98 | $61.68 | $1,767.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.87 / $13.35 / $320.39
| Professional | | $12.87 | $13.35 | $320.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.65 / $30.20 / $33.90
| Professional | | $22.65 | $30.20 | $33.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.93 / $17.10 / $21.50
| Professional | | $16.93 | $17.10 | $21.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.49 / $22.49 / $100.00
| Facility | | $10.49 | $22.49 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.43 / $17.98 / $25.70
| Professional | | $7.43 | $17.98 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.30 / $10.49 / $25.70
| Professional | | $6.30 | $10.49 | $25.70 |