- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $38.61 / $72.51 / $112.04
| Facility | | $38.61 | $72.51 | $112.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.32 / $30.53 / $37.54
| Professional | | $26.32 | $30.53 | $37.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.79 / $35.79 / $35.79
| Professional | | $35.79 | $35.79 | $35.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.02 / $57.48 / $79.91
| Facility | | $31.02 | $57.48 | $79.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.07 / $35.09 / $47.21
| Facility | | $28.07 | $35.09 | $47.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.74 / $21.05 / $175.45
| Professional | | $14.74 | $21.05 | $175.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.05 / $35.09 / $96.50
| Facility | | $21.05 | $35.09 | $96.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.74 / $21.05 / $52.64
| Professional | | $14.74 | $21.05 | $52.64 |