- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.48 / $35.48 / $56.23
| Facility | | $35.48 | $35.48 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $44.67 / $107.15
| Professional | | $28.84 | $44.67 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $32.36
| Professional | | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $60.26 / $69.18
| Professional | | $40.74 | $60.26 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.18 / $45.71 / $51.29
| Facility | | $28.18 | $45.71 | $51.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.85 / $27.54 / $81.28
| Professional | | $15.85 | $27.54 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $47.86 / $79.43
| Professional | | $22.91 | $47.86 | $79.43 |