- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.13 / $42.13 / $45.13
| Facility | | $42.13 | $42.13 | $45.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.13 / $42.13 / $42.13
| Professional | | $42.13 | $42.13 | $42.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.81 / $99.22 / $201.90
| Facility | | $78.81 | $99.22 | $201.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.07 / $78.17 / $84.34
| Professional | | $39.07 | $78.17 | $84.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.10 / $93.42 / $116.77
| Professional | | $59.10 | $93.42 | $116.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.86 / $75.83 / $244.29
| Facility | | $30.86 | $75.83 | $244.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.78 / $25.33 / $76.76
| Professional | | $22.78 | $25.33 | $76.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $58.21 / $72.00 / $105.95
| Facility | | $58.21 | $72.00 | $105.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.21 / $75.45 / $110.19
| Professional | | $58.21 | $75.45 | $110.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.54 / $25.33 / $76.76
| Professional | | $22.54 | $25.33 | $76.76 |