- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.70 / $805.25 / $1,680.97
| Facility | | $25.70 | $805.25 | $1,680.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.66 / $44.58 / $229.00
| Professional | | $15.66 | $44.58 | $229.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.28 / $21.42 / $25.92
| Professional | | $19.28 | $21.42 | $25.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.66 / $16.85 / $52.31
| Professional | | $11.66 | $16.85 | $52.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.42 / $26.78 / $40.86
| Professional | | $21.42 | $26.78 | $40.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.85 / $19.28 / $37.40
| Professional | | $12.85 | $19.28 | $37.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.71 / $21.02 / $21.02
| Professional | | $10.71 | $21.02 | $21.02 |