- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.48 / $99.18 / $103.32
| Facility | | $9.48 | $99.18 | $103.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.48 / $11.72 / $15.82
| Professional | | $9.48 | $11.72 | $15.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.46 / $27.28 / $30.62
| Professional | | $20.46 | $27.28 | $30.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.69 / $15.85 / $19.93
| Professional | | $15.69 | $15.85 | $19.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.48 / $20.30 / $108.80
| Facility | | $9.48 | $20.30 | $108.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.72 / $16.25 / $23.23
| Professional | | $6.72 | $16.25 | $23.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.69 / $15.23 / $23.23
| Professional | | $5.69 | $15.23 | $23.23 |