- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.37 / $18.37 / $47.23
| Facility | | $18.37 | $18.37 | $47.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.37 / $18.37 / $24.67
| Professional | | $18.37 | $18.37 | $24.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.65 / $52.87 / $59.34
| Professional | | $39.65 | $52.87 | $59.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.15 / $30.45 / $38.29
| Professional | | $30.15 | $30.45 | $38.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.37 / $36.65 / $124.64
| Facility | | $18.37 | $36.65 | $124.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.69 / $31.49 / $44.61
| Professional | | $11.69 | $31.49 | $44.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.02 / $16.50 / $40.44
| Professional | | $11.02 | $16.50 | $40.44 |