- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.81 / $21.05 / $25.26
| Facility | | $13.81 | $21.05 | $25.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.63 / $13.64 / $13.81
| Professional | | $12.63 | $13.64 | $13.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.52 / $22.73 / $25.26
| Facility | | $18.52 | $22.73 | $25.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.21 / $20.21 / $22.73
| Professional | | $20.21 | $20.21 | $22.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.69 / $20.21 / $50.53
| Facility | | $13.69 | $20.21 | $50.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.58 / $24.26 / $106.51
| Professional | | $9.58 | $24.26 | $106.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.58 / $10.32 / $44.50
| Professional | | $7.58 | $10.32 | $44.50 |