- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.80 / $145.68 / $1,339.07
| Facility | | $57.80 | $145.68 | $1,339.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.40 / $43.27 / $115.29
| Professional | | $11.40 | $43.27 | $115.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.26 / $57.08 / $75.28
| Professional | | $15.26 | $57.08 | $75.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.09 / $29.37 / $37.72
| Professional | | $23.09 | $29.37 | $37.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.43 / $26.67 / $72.50
| Professional | | $13.43 | $26.67 | $72.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.62 / $72.93 / $107.25
| Professional | | $48.62 | $72.93 | $107.25 |