- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.57 / $58.25 / $188.10
| Facility | | $23.57 | $58.25 | $188.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.54 / $12.85 / $13.67
| Professional | | $12.54 | $12.85 | $13.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.95 / $17.70 / $29.20
| Facility | | $16.95 | $17.70 | $29.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.55 / $10.79 / $27.40
| Professional | | $7.55 | $10.79 | $27.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.51 / $34.35 / $60.38
| Facility | | $13.51 | $34.35 | $60.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.38 / $15.91 / $20.65
| Professional | | $10.38 | $15.91 | $20.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.04 / $10.51 / $23.02
| Professional | | $5.04 | $10.51 | $23.02 |