- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.00 / $30.03 / $37.54
| Professional | | $19.00 | $30.03 | $37.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.46 / $103.00 / $103.00
| Facility | | $18.46 | $103.00 | $103.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.00 / $31.00 / $31.00
| Professional | | $31.00 | $31.00 | $31.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.38 / $14.63 / $14.63
| Facility | | $10.38 | $14.63 | $14.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.38 / $17.73 / $29.11
| Professional | | $10.38 | $17.73 | $29.11 |