- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.15 / $98.76 / $208.94
| Facility | | $32.15 | $98.76 | $208.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.01 / $72.80 / $83.31
| Professional | | $20.01 | $72.80 | $83.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.01 / $60.01 / $60.01
| Facility | | $60.01 | $60.01 | $60.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.97 / $24.78 / $30.98
| Professional | | $15.97 | $24.78 | $30.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.71 / $19.71 / $19.71
| Facility | | $19.71 | $19.71 | $19.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.73 / $21.73 / $86.92
| Professional | | $21.73 | $21.73 | $86.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.06 / $83.66 / $140.21
| Facility | | $76.06 | $83.66 | $140.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.55 / $48.89 / $48.89
| Professional | | $19.55 | $48.89 | $48.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.71 / $19.71 / $76.06
| Facility | | $19.71 | $19.71 | $76.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.73 / $21.74 / $28.10
| Professional | | $21.73 | $21.74 | $28.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.66 / $43.46 / $65.56
| Professional | | $13.66 | $43.46 | $65.56 |