- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $16.60 / $118.29
| Professional | | $16.60 | $16.60 | $118.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.27 / $24.27 / $32.49
| Facility | | $24.27 | $24.27 | $32.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.63 / $24.27 / $42.38
| Professional | | $20.63 | $24.27 | $42.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.20 / $26.07 / $34.22
| Professional | | $16.20 | $26.07 | $34.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2.00 / $18.39 / $31.76
| Facility | | $2.00 | $18.39 | $31.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.60 / $20.05 / $36.88
| Professional | | $16.60 | $20.05 | $36.88 |