- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.31 / $115.62 / $238.50
| Facility | | $30.31 | $115.62 | $238.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.96 / $16.48 / $20.37
| Professional | | $12.96 | $16.48 | $20.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.81 / $22.78 / $37.54
| Facility | | $21.81 | $22.78 | $37.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.72 / $13.89 / $35.26
| Professional | | $9.72 | $13.89 | $35.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.26 / $44.20 / $77.70
| Facility | | $17.26 | $44.20 | $77.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.42 / $20.48 / $26.33
| Professional | | $13.42 | $20.48 | $26.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $13.52 / $29.63
| Professional | | $5.25 | $13.52 | $29.63 |