- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.77 / $50.50 / $65.54
| Facility | | $32.77 | $50.50 | $65.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $32.77 / $37.69
| Professional | | $20.00 | $32.77 | $37.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $36.58 / $44.39 / $59.72
| Facility | | $36.58 | $44.39 | $59.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.23 / $21.26 / $24.58
| Professional | | $20.23 | $21.26 | $24.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.37 / $26.63 / $102.69
| Facility | | $22.37 | $26.63 | $102.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.74 / $23.34 / $46.98
| Professional | | $13.74 | $23.34 | $46.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.76 / $13.78 / $32.77
| Professional | | $13.76 | $13.78 | $32.77 |