- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $29.56 / $54.12 / $138.63
| Facility | | $29.56 | $54.12 | $138.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.73 / $16.07 / $32.15
| Professional | | $15.73 | $16.07 | $32.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.58 / $28.40 / $36.63
| Facility | | $24.58 | $28.40 | $36.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.07 / $18.07 / $34.38
| Professional | | $18.07 | $18.07 | $34.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.01 / $43.10 / $75.77
| Facility | | $17.01 | $43.10 | $75.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.06 / $19.97 / $35.11
| Professional | | $13.06 | $19.97 | $35.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.44 / $14.47 / $35.72
| Professional | | $8.44 | $14.47 | $35.72 |