- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.07 / $16.07 / $110.54
| Facility | | $16.07 | $16.07 | $110.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.46 / $12.53 / $12.53
| Professional | | $10.46 | $12.53 | $12.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.55 / $20.55 / $24.66
| Facility | | $20.55 | $20.55 | $24.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.09 / $25.00 / $51.00
| Professional | | $20.09 | $25.00 | $51.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.10 / $32.10 / $32.10
| Facility | | $32.10 | $32.10 | $32.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.44 / $18.59 / $23.23
| Professional | | $7.44 | $18.59 | $23.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.75 / $6.75 / $16.76
| Professional | | $6.75 | $6.75 | $16.76 |