- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.16 / $105.64 / $138.50
| Facility | | $20.16 | $105.64 | $138.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.16 / $20.16 / $20.16
| Professional | | $20.16 | $20.16 | $20.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.68 / $27.44 / $86.01
| Facility | | $26.68 | $27.44 | $86.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.76 / $32.26 / $56.91
| Professional | | $13.76 | $32.26 | $56.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.22 / $35.90 / $126.44
| Facility | | $31.22 | $35.90 | $126.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.59 / $28.43 / $37.51
| Professional | | $22.59 | $28.43 | $37.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.85 / $13.11 / $18.73
| Professional | | $11.85 | $13.11 | $18.73 |