- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.05 / $30.72 / $91.00
| Facility | | $16.05 | $30.72 | $91.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.64 / $18.61 / $27.88
| Professional | | $13.64 | $18.61 | $27.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27.96 / $27.96 / $27.96
| Facility | | $27.96 | $27.96 | $27.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.77 / $32.69 / $48.15
| Professional | | $22.77 | $32.69 | $48.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $53.50 / $65.00 / $77.00
| Facility | | $53.50 | $65.00 | $77.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.52 / $32.39 / $45.00
| Professional | | $16.52 | $32.39 | $45.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.05 / $26.86 / $42.84
| Facility | | $16.05 | $26.86 | $42.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.37 / $32.33 / $48.13
| Professional | | $22.37 | $32.33 | $48.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.70 / $36.07 / $55.95
| Professional | | $24.70 | $36.07 | $55.95 |