- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.24 / $27.94 / $32.75
| Facility | | $24.24 | $27.94 | $32.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.05 / $22.37 / $32.75
| Professional | | $17.05 | $22.37 | $32.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.61 / $24.25 / $30.61
| Professional | | $20.61 | $24.25 | $30.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.32 / $20.41 / $24.78
| Facility | | $20.32 | $20.41 | $24.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.00 / $23.00 / $37.97
| Professional | | $16.00 | $23.00 | $37.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.62 / $23.36 / $42.62
| Professional | | $17.62 | $23.36 | $42.62 |