- 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
- $13.33 / $14.51 / $18.10
| Professional | | $13.33 | $14.51 | $18.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.41 / $9.90 / $24.31
| Professional | | $5.41 | $9.90 | $24.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.26 / $13.00 / $16.00
| Professional | | $5.26 | $13.00 | $16.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.63 / $45.00 / $45.00
| Professional | | $6.63 | $45.00 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.40 / $7.45 / $13.87
| Professional | | $4.40 | $7.45 | $13.87 |