- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.01 / $13.00 / $72.00
| Professional | | $11.01 | $13.00 | $72.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $45.43 / $99.07 / $150.30
| Facility | | $45.43 | $99.07 | $150.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.63 / $16.84 / $52.80
| Professional | | $15.63 | $16.84 | $52.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.19 / $81.30 / $116.06
| Professional | | $15.19 | $81.30 | $116.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.19 / $81.30 / $116.06
| Professional | | $15.19 | $81.30 | $116.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.43 / $20.53 / $21.78
| Professional | | $14.43 | $20.53 | $21.78 |