- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.10 / $96.94 / $161.25
| Facility | | $50.10 | $96.94 | $161.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.01 / $16.59 / $22.30
| Professional | | $13.01 | $16.59 | $22.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.89 / $16.34 / $51.21
| Facility | | $15.89 | $16.34 | $51.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.69 / $21.06 / $26.33
| Professional | | $11.69 | $21.06 | $26.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.57 / $21.37 / $83.63
| Facility | | $18.57 | $21.37 | $83.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.22 / $15.19 / $21.55
| Professional | | $14.22 | $15.19 | $21.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.80 / $7.80 / $11.15
| Professional | | $7.80 | $7.80 | $11.15 |