- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.32 / $80.81 / $235.52
| Facility | | $12.32 | $80.81 | $235.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.73 / $14.40 / $14.40
| Professional | | $9.73 | $14.40 | $14.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8.01 / $8.01 / $8.01
| Facility | | $8.01 | $8.01 | $8.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.88 / $14.04 / $23.07
| Professional | | $8.88 | $14.04 | $23.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.32 / $32.77 / $141.40
| Facility | | $12.32 | $32.77 | $141.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.17 / $7.02 / $17.22
| Professional | | $5.17 | $7.02 | $17.22 |