- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.00 / $58.22 / $79.52
| Facility | | $24.00 | $58.22 | $79.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.00 / $20.12 / $42.43
| Professional | | $16.00 | $20.12 | $42.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.03 / $20.03 / $20.03
| Professional | | $20.03 | $20.03 | $20.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.10 / $22.10 / $22.10
| Professional | | $22.10 | $22.10 | $22.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.22 / $35.00 / $35.00
| Professional | | $33.22 | $35.00 | $35.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.35 / $23.53 / $26.82
| Professional | | $22.35 | $23.53 | $26.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.35 / $22.35 / $22.35
| Professional | | $22.35 | $22.35 | $22.35 |