- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.64 / $123.87 / $162.41
| Facility | | $23.64 | $123.87 | $162.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.06 / $30.25 / $35.75
| Professional | | $25.06 | $30.25 | $35.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.94 / $29.77 / $93.30
| Facility | | $28.94 | $29.77 | $93.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.35 / $39.24 / $49.04
| Professional | | $21.35 | $39.24 | $49.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.86 / $38.94 / $152.36
| Facility | | $33.86 | $38.94 | $152.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.92 / $27.68 / $39.10
| Professional | | $25.92 | $27.68 | $39.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.22 / $20.02 / $20.32
| Professional | | $14.22 | $20.02 | $20.32 |