- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.58 / $82.81 / $188.10
| Facility | | $23.58 | $82.81 | $188.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.36 / $12.86 / $13.07
| Professional | | $9.36 | $12.86 | $13.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.97 / $17.72 / $29.21
| Facility | | $16.97 | $17.72 | $29.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.57 / $10.81 / $27.42
| Professional | | $7.57 | $10.81 | $27.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13.51 / $34.36 / $60.43
| Facility | | $13.51 | $34.36 | $60.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.38 / $15.92 / $21.17
| Professional | | $10.38 | $15.92 | $21.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.25 / $12.07 / $28.50
| Professional | | $5.25 | $12.07 | $28.50 |