- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.70 / $54.67 / $153.54
| Facility | | $40.70 | $54.67 | $153.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.71 / $33.93 / $127.77
| Professional | | $18.71 | $33.93 | $127.77 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $50.51 / $59.03 / $59.03
| Professional | 25 | $50.51 | $59.03 | $59.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.57 / $28.57 / $28.57
| Professional | | $28.57 | $28.57 | $28.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.84 / $32.34 / $43.66
| Professional | | $24.84 | $32.34 | $43.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.06 / $39.00 / $47.55
| Professional | | $32.06 | $39.00 | $47.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.07 / $37.83 / $58.13
| Professional | | $30.07 | $37.83 | $58.13 |