- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.00 / $56.23 / $1,778.28
| Facility | | $10.00 | $56.23 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $13.49 / $346.74
| Professional | | $12.88 | $13.49 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.88 / $30.20 / $33.88
| Professional | | $21.88 | $30.20 | $33.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.98 / $16.98 / $21.38
| Professional | | $16.98 | $16.98 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.47 / $22.39 / $50.12
| Facility | | $10.47 | $22.39 | $50.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $10.47 / $25.70
| Professional | | $7.41 | $10.47 | $25.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.41 / $15.14 / $25.70
| Professional | | $7.41 | $15.14 | $25.70 |