- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.94 / $113.65 / $1,339.07
| Facility | | $55.94 | $113.65 | $1,339.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.31 / $21.72 / $78.62
| Professional | | $10.31 | $21.72 | $78.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.38 / $13.54 / $20.96
| Professional | | $12.38 | $13.54 | $20.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.62 / $24.21 / $60.00
| Professional | | $23.62 | $24.21 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.39 / $14.09 / $15.46
| Professional | | $11.39 | $14.09 | $15.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.23 / $15.30 / $22.21
| Professional | | $10.23 | $15.30 | $22.21 |