- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $7,943.28 / $9,772.37
| Facility | | $20.42 | $7,943.28 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $19.95 / $5,128.61
| Professional | | $19.95 | $19.95 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $16.98 / $16.98
| Professional | | $16.98 | $16.98 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.95 / $20.42 / $20.42
| Professional | | $19.95 | $20.42 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.42 / $20.42 / $20.42
| Facility | | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $20.42 / $20.42
| Professional | | $20.42 | $20.42 | $20.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.50 / $20.42 / $23.44
| Facility | | $19.50 | $20.42 | $23.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.42 / $20.42 / $20.42
| Professional | | $20.42 | $20.42 | $20.42 |