- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.40 / $10.40 / $26.75
| Facility | | $10.40 | $10.40 | $26.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.40 / $10.40 / $13.97
| Professional | | $10.40 | $10.40 | $13.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.37 / $29.94 / $33.56
| Professional | | $22.37 | $29.94 | $33.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.93 / $16.93 / $24.86
| Professional | | $16.93 | $16.93 | $24.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.92 / $11.29 / $26.75
| Facility | | $8.92 | $11.29 | $26.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.58 / $17.82 / $29.72
| Professional | | $7.58 | $17.82 | $29.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.24 / $18.57 / $21.55
| Professional | | $6.24 | $18.57 | $21.55 |