- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.00 / $265.00 / $420.08
| Facility | | $15.00 | $265.00 | $420.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.32 / $15.00 / $450.00
| Professional | | $14.32 | $15.00 | $450.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.31 / $14.50 / $24.31
| Professional | | $10.31 | $14.50 | $24.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $15.97 / $37.71
| Professional | | $10.30 | $15.97 | $37.71 |
- 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
- $29.99 / $49.00 / $104.74
| Professional | | $29.99 | $49.00 | $104.74 |