- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.28 / $147.60 / $188.56
| Facility | | $96.28 | $147.60 | $188.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $16.23 / $105.30
| Professional | | $0.02 | $16.23 | $105.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.00 / $34.79 / $38.86
| Professional | | $26.00 | $34.79 | $38.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.82 / $20.02 / $25.18
| Professional | | $19.82 | $20.02 | $25.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14.81 / $76.77 / $125.82
| Facility | | $14.81 | $76.77 | $125.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.25 / $17.27 / $29.36
| Professional | | $7.25 | $17.27 | $29.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.25 / $20.72 / $25.04
| Professional | | $7.25 | $20.72 | $25.04 |