- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.78 / $40.74 / $107.15
| Facility | | $17.78 | $40.74 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $25.70 / $61.66
| Professional | | $18.20 | $25.70 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $26.30 / $33.11
| Professional | | $17.38 | $26.30 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $79.43 / $138.04
| Facility | | $74.13 | $79.43 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.91 / $31.62 / $57.54
| Professional | | $22.91 | $31.62 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $31.62 / $31.62
| Professional | | $30.20 | $31.62 | $31.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $29.51 / $46.77
| Professional | | $21.38 | $29.51 | $46.77 |