- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $24.52 / $2,112.44
| Facility | | $20.42 | $24.52 | $2,112.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.57 / $19.94 / $20.43
| Professional | | $16.57 | $19.94 | $20.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.00 / $20.00 / $22.00
| Facility | | $17.00 | $20.00 | $22.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.43 / $20.43 / $20.43
| Professional | | $20.43 | $20.43 | $20.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.94 / $89.44 / $13,785.00
| Facility | | $19.94 | $89.44 | $13,785.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $20.43 / $20.43
| Professional | | $18.20 | $20.43 | $20.43 |