- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.64 / $27.64 / $27.64
| Facility | | $27.64 | $27.64 | $27.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.57 / $30.68 / $177.73
| Professional | | $16.57 | $30.68 | $177.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.22 / $25.53 / $34.56
| Professional | | $17.22 | $25.53 | $34.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.64 / $27.64 / $27.64
| Facility | | $27.64 | $27.64 | $27.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.82 / $16.55 / $53.92
| Professional | | $6.82 | $16.55 | $53.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.63 / $22.88 / $51.72
| Professional | | $8.63 | $22.88 | $51.72 |