- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $42.27 / $164.62 / $239.40
| Facility | | $42.27 | $164.62 | $239.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.07 / $22.09 / $25.81
| Professional | | $18.07 | $22.09 | $25.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.40 / $31.75 / $52.36
| Facility | | $30.40 | $31.75 | $52.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.55 / $19.36 / $49.15
| Professional | | $13.55 | $19.36 | $49.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.27 / $61.62 / $108.33
| Facility | | $24.27 | $61.62 | $108.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.61 / $28.54 / $37.17
| Professional | | $18.61 | $28.54 | $37.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.02 / $18.09 / $41.30
| Professional | | $9.02 | $18.09 | $41.30 |