- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.66 / $25.66 / $33.85
| Facility | | $25.66 | $25.66 | $33.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.32 / $27.70 / $36.63
| Professional | | $21.32 | $27.70 | $36.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.97 / $31.31 / $49.21
| Professional | | $22.97 | $31.31 | $49.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.43 / $39.63 / $95.68
| Professional | | $26.43 | $39.63 | $95.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.67 / $41.31 / $86.08
| Professional | | $23.67 | $41.31 | $86.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.79 / $51.73 / $109.76
| Professional | | $37.79 | $51.73 | $109.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.93 / $25.30 / $30.36
| Professional | | $18.93 | $25.30 | $30.36 |