- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $52.75 / $147.57 / $898.13
| Facility | | $52.75 | $147.57 | $898.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $17.04
| Professional | | $10.30 | $10.30 | $17.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.68 / $15.71 / $24.37
| Professional | | $14.68 | $15.71 | $24.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.28 / $18.04 / $22.32
| Professional | | $12.28 | $18.04 | $22.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.50 / $316.50 / $316.50
| Facility | | $316.50 | $316.50 | $316.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.54 / $13.35 / $20.48
| Professional | | $11.54 | $13.35 | $20.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.66 / $135.97 / $679.83
| Facility | | $59.66 | $135.97 | $679.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.30 / $10.30 / $17.04
| Professional | | $10.30 | $10.30 | $17.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.78 / $19.57 / $23.91
| Professional | | $12.78 | $19.57 | $23.91 |