- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.69 / $56.25 / $74.69
| Facility | | $31.69 | $56.25 | $74.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.96 / $26.41 / $66.03
| Professional | | $18.96 | $26.41 | $66.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.07 / $33.86 / $42.33
| Facility | | $15.07 | $33.86 | $42.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.54 / $13.54 / $37.40
| Professional | | $13.54 | $13.54 | $37.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.01 / $39.61 / $55.03
| Facility | | $22.01 | $39.61 | $55.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.09 / $41.59 / $49.83
| Professional | | $27.09 | $41.59 | $49.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.47 / $8.47 / $35.54
| Professional | | $8.47 | $8.47 | $35.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.47 / $8.47 / $8.47
| Professional | | $8.47 | $8.47 | $8.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.22 / $14.22 / $33.86
| Professional | | $14.22 | $14.22 | $33.86 |