- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.27 / $151.74 / $240.26
| Facility | | $117.27 | $151.74 | $240.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $25.81 / $53.28
| Professional | | $20.72 | $25.81 | $53.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.21 / $59.64 / $66.93
| Professional | | $49.21 | $59.64 | $66.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.28 / $34.61 / $43.53
| Professional | | $34.28 | $34.61 | $43.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.60 / $118.91 / $273.02
| Facility | | $29.60 | $118.91 | $273.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.80 / $35.52 / $73.26
| Professional | | $14.80 | $35.52 | $73.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.43 / $20.71 / $50.76
| Professional | | $12.43 | $20.71 | $50.76 |