- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.16 / $33.68 / $58.88
| Facility | | $12.16 | $33.68 | $58.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.00 / $12.96 / $15.20
| Professional | | $12.00 | $12.96 | $15.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.91 / $46.24 / $73.28
| Facility | | $16.91 | $46.24 | $73.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.72 / $16.00 / $16.00
| Professional | | $6.72 | $16.00 | $16.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.36 / $14.04 / $41.18
| Facility | | $9.36 | $14.04 | $41.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.83 / $18.17 / $22.72
| Professional | | $10.83 | $18.17 | $22.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.16 / $13.28 / $20.43
| Facility | | $12.16 | $13.28 | $20.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.72 / $20.80 / $29.60
| Professional | | $10.72 | $20.80 | $29.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.00 / $24.00 / $24.00
| Facility | | $24.00 | $24.00 | $24.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.72 / $6.72 / $11.84
| Professional | | $6.72 | $6.72 | $11.84 |