- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.00 / $18.00 / $21.98
| Professional | | $18.00 | $18.00 | $21.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $5.60 / $5.60
| Professional | | $4.00 | $5.60 | $5.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.00 / $22.00 / $25.45
| Professional | | $11.00 | $22.00 | $25.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.30 / $18.00 / $26.41
| Facility | | $15.30 | $18.00 | $26.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.65 / $31.31 / $154.65
| Professional | | $23.65 | $31.31 | $154.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.12 / $28.26 / $50.67
| Professional | | $24.12 | $28.26 | $50.67 |