- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.43 / $10.43 / $26.82
| Facility | | $10.43 | $10.43 | $26.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.43 / $10.43 / $14.01
| Professional | | $10.43 | $10.43 | $14.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.52 / $30.02 / $33.70
| Professional | | $22.52 | $30.02 | $33.70 |
- 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
- $10.43 / $22.35 / $91.80
| Facility | | $10.43 | $22.35 | $91.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.39 / $17.88 / $25.55
| Professional | | $7.39 | $17.88 | $25.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.26 / $15.20 / $25.55
| Professional | | $6.26 | $15.20 | $25.55 |