- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.97 / $35.40 / $241.02
| Facility | | $13.97 | $35.40 | $241.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.97 / $20.82 / $38.88
| Professional | | $13.97 | $20.82 | $38.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.59 / $27.44 / $39.24
| Professional | | $18.59 | $27.44 | $39.24 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $27.88 / $41.16 / $58.86
| Professional | 50 | $27.88 | $41.16 | $58.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.27 / $31.14 / $51.66
| Professional | | $19.27 | $31.14 | $51.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.61 / $30.39 / $50.66
| Professional | | $20.61 | $30.39 | $50.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.40 / $35.40 / $241.02
| Facility | | $35.40 | $35.40 | $241.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.97 / $20.82 / $45.45
| Professional | | $13.97 | $20.82 | $45.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.16 / $37.38 / $49.37
| Professional | | $25.16 | $37.38 | $49.37 |