- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.00 / $130.00 / $420.08
| Facility | | $14.00 | $130.00 | $420.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.00 / $14.51 / $18.23
| Professional | | $14.00 | $14.51 | $18.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.21 / $22.61 / $42.87
| Professional | | $18.21 | $22.61 | $42.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $15.00 / $52.17
| Professional | | $10.30 | $15.00 | $52.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $45.00
| Professional | | $45.00 | $45.00 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.18 / $60.75 / $122.75
| Professional | | $37.18 | $60.75 | $122.75 |