- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.64 / $28.64 / $35.84
| Professional | | $21.64 | $28.64 | $35.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.48 / $25.48 / $30.42
| Professional | | $25.48 | $25.48 | $30.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.64 / $25.86 / $37.68
| Professional | | $16.64 | $25.86 | $37.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.75 / $24.32 / $181.68
| Professional | | $15.75 | $24.32 | $181.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.75 / $23.87 / $39.06
| Professional | | $15.75 | $23.87 | $39.06 |