- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.62 / $234.42 / $398.11
| Facility | | $18.62 | $234.42 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.13 / $15.49 / $56.23
| Professional | | $14.13 | $15.49 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.02 / $12.02 / $12.02
| Facility | | $12.02 | $12.02 | $12.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.77 / $21.38 / $26.92
| Professional | | $9.77 | $21.38 | $26.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.62 / $50.12 / $263.03
| Facility | | $18.62 | $50.12 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.46 / $10.00 / $28.18
| Professional | | $6.46 | $10.00 | $28.18 |