- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.47 / $54.57 / $148.88
| Facility | | $25.47 | $54.57 | $148.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.62 / $26.37 / $33.96
| Professional | | $23.62 | $26.37 | $33.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.53 / $37.72 / $102.17
| Facility | | $29.53 | $37.72 | $102.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.45 / $14.58 / $33.02
| Professional | | $13.45 | $14.58 | $33.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.66 / $48.69 / $98.31
| Facility | | $20.66 | $48.69 | $98.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.64 / $33.86 / $44.03
| Professional | | $18.64 | $33.86 | $44.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $75.00
| Facility | | $75.00 | $75.00 | $75.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.40 / $17.72 / $41.26
| Professional | | $12.40 | $17.72 | $41.26 |