- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.03 / $20.03 / $40.08
| Professional | | $20.03 | $20.03 | $40.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.12 / $30.12 / $30.12
| Professional | | $30.12 | $30.12 | $30.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.72 / $66.43 / $128.13
| Facility | | $33.72 | $66.43 | $128.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.40 / $25.61 / $32.01
| Professional | | $11.40 | $25.61 | $32.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.72 / $66.43 / $128.13
| Facility | | $33.72 | $66.43 | $128.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.23 / $20.23 / $26.98
| Professional | | $20.23 | $20.23 | $26.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $13.49 / $22.71
| Professional | | $13.49 | $13.49 | $22.71 |