- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.82 / $77.86 / $242.13
| Facility | | $57.82 | $77.86 | $242.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.10 / $19.60 / $20.32
| Professional | | $14.10 | $19.60 | $20.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.07 / $18.98 / $25.81
| Professional | | $17.07 | $18.98 | $25.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.37 / $17.82 / $35.08
| Facility | | $14.37 | $17.82 | $35.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.37 / $25.91 / $39.24
| Professional | | $14.37 | $25.91 | $39.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.11 / $33.89 / $40.67
| Professional | | $27.11 | $33.89 | $40.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.39 / $12.60 / $17.62
| Professional | | $11.39 | $12.60 | $17.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.57 / $10.84 / $13.56
| Professional | | $10.57 | $10.84 | $13.56 |