- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $263.03 / $1,905.46
| Facility | | $56.23 | $263.03 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $28.18 / $100.00
| Professional | | $10.00 | $28.18 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.47 / $13.49 / $17.78
| Professional | | $10.47 | $13.49 | $17.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $13.49 / $16.60
| Professional | | $11.48 | $13.49 | $16.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $23.44 / $28.84
| Professional | | $11.48 | $23.44 | $28.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.79 / $16.60 / $22.91
| Professional | | $14.79 | $16.60 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $15.14 / $22.39
| Professional | | $10.00 | $15.14 | $22.39 |