- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.19 / $161.85 / $194.87
| Facility | | $10.19 | $161.85 | $194.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.19 / $12.69 / $88.20
| Professional | | $10.19 | $12.69 | $88.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.94 / $29.36 / $32.78
| Professional | | $21.94 | $29.36 | $32.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.93 / $17.10 / $21.50
| Professional | | $16.93 | $17.10 | $21.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.19 / $21.86 / $75.23
| Facility | | $10.19 | $21.86 | $75.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.83 / $17.48 / $24.98
| Professional | | $6.83 | $17.48 | $24.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.12 / $14.57 / $24.98
| Professional | | $6.12 | $14.57 | $24.98 |