- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.88 / $13.88 / $343.00
| Facility | | $13.88 | $13.88 | $343.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.33 / $14.56 / $26.58
| Professional | | $13.33 | $14.56 | $26.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.35 / $10.63 / $12.50
| Professional | | $8.35 | $10.63 | $12.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.00 / $110.00 / $110.00
| Facility | | $110.00 | $110.00 | $110.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.00 / $23.89 / $37.44
| Professional | | $10.00 | $23.89 | $37.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.79 / $35.67 / $64.04
| Professional | | $27.79 | $35.67 | $64.04 |