- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.77 / $9.15 / $12.93
| Professional | | $6.77 | $9.15 | $12.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.00 / $101.57 / $117.44
| Facility | | $52.00 | $101.57 | $117.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.20 / $52.00 / $52.00
| Professional | | $44.20 | $52.00 | $52.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.65 / $28.65 / $28.65
| Facility | | $28.65 | $28.65 | $28.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.91 / $28.65 / $28.65
| Professional | | $20.91 | $28.65 | $28.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.63 / $10.11 / $15.14
| Professional | | $6.63 | $10.11 | $15.14 |