- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.00 / $78.75 / $103.05
| Facility | | $15.00 | $78.75 | $103.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.76 / $9.80 / $15.00
| Professional | | $8.76 | $9.80 | $15.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.13 / $10.41 / $32.64
| Facility | | $10.13 | $10.41 | $32.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.48 / $13.63 / $17.04
| Professional | | $7.48 | $13.63 | $17.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11.84 / $13.62 / $53.26
| Facility | | $11.84 | $13.62 | $53.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.06 / $9.76 / $13.57
| Professional | | $9.06 | $9.76 | $13.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.97 / $7.00 / $7.10
| Professional | | $4.97 | $7.00 | $7.10 |