- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.04 / $13.04 / $20.86
| Facility | | $13.04 | $13.04 | $20.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.01 / $17.87 / $34.32
| Professional | | $10.01 | $17.87 | $34.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.92 / $22.84 / $42.66
| Professional | | $14.92 | $22.84 | $42.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.01 / $33.76 / $224.51
| Professional | | $19.01 | $33.76 | $224.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $24.44 / $38.63
| Professional | | $13.06 | $24.44 | $38.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.20 / $26.40 / $39.75
| Professional | | $19.20 | $26.40 | $39.75 |