- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.06 / $36.47 / $120.05
| Facility | | $22.06 | $36.47 | $120.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $21.34 / $26.10
| Professional | | $20.72 | $21.34 | $26.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.20 / $31.38 / $224.08
| Facility | | $11.20 | $31.38 | $224.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $20.72
| Facility | | $20.72 | $20.72 | $20.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $20.72
| Professional | | $20.72 | $20.72 | $20.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.08 / $29.01 / $52.48
| Professional | | $8.08 | $29.01 | $52.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.94 / $26.94 / $26.94
| Professional | | $26.94 | $26.94 | $26.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $22.72
| Professional | | $20.72 | $20.72 | $22.72 |