- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.07 / $22.07 / $350.58
| Facility | | $22.07 | $22.07 | $350.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.66 / $17.63 / $32.43
| Professional | | $15.66 | $17.63 | $32.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.81 / $23.81 / $23.81
| Professional | | $23.81 | $23.81 | $23.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $15.00 / $15.00
| Professional | | $15.00 | $15.00 | $15.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.29 / $25.38 / $43.46
| Facility | | $16.29 | $25.38 | $43.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $14.65 / $146.31
| Professional | | $9.77 | $14.65 | $146.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $14.65 / $21.02
| Professional | | $9.77 | $14.65 | $21.02 |