- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.66 / $14.66 / $58.64
| Facility | | $14.66 | $14.66 | $58.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.21 / $14.66 / $15.20
| Professional | | $10.21 | $14.66 | $15.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.32 / $14.50 / $43.00
| Professional | | $11.32 | $14.50 | $43.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.38 / $8.38 / $21.07
| Professional | | $8.38 | $8.38 | $21.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.05 / $37.40 / $54.87
| Professional | | $25.05 | $37.40 | $54.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.31 / $31.81 / $1,500.00
| Professional | | $8.31 | $31.81 | $1,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $15.00 / $23.15
| Professional | | $15.00 | $15.00 | $23.15 |