- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.05 / $97.63 / $142.47
| Facility | | $18.05 | $97.63 | $142.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.05 / $18.05 / $18.05
| Professional | | $18.05 | $18.05 | $18.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.57 / $18.43 / $34.54
| Professional | | $12.57 | $18.43 | $34.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.71 / $73.89 / $114.30
| Facility | | $52.71 | $73.89 | $114.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.30 / $22.76 / $29.40
| Professional | | $19.30 | $22.76 | $29.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.04 / $23.32 / $32.34
| Professional | | $13.04 | $23.32 | $32.34 |