- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.23 / $41.35 / $373.52
| Facility | | $18.23 | $41.35 | $373.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.07 / $22.62 / $22.62
| Professional | | $16.07 | $22.62 | $22.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.60 / $12.60 / $12.60
| Facility | | $12.60 | $12.60 | $12.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.85 / $22.30 / $36.32
| Professional | | $13.85 | $22.30 | $36.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.23 / $51.55 / $129.61
| Facility | | $12.23 | $51.55 | $129.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.14 / $11.63 / $27.08
| Professional | | $8.14 | $11.63 | $27.08 |