- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.43 / $28.10 / $33.72
| Facility | | $18.43 | $28.10 | $33.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.86 / $18.43 / $22.50
| Professional | | $16.86 | $18.43 | $22.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.48 / $30.35 / $37.09
| Facility | | $22.48 | $30.35 | $37.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.48 / $28.10 / $30.35
| Professional | | $22.48 | $28.10 | $30.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.26 / $26.98 / $67.43
| Facility | | $18.26 | $26.98 | $67.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.44 / $32.01 / $108.35
| Professional | | $9.44 | $32.01 | $108.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9.44 / $9.44 / $9.44
| Facility | | $9.44 | $9.44 | $9.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.49 / $14.15 / $31.83
| Professional | | $13.49 | $14.15 | $31.83 |