- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18.03 / $757.53 / $1,458.72
| Facility | | $18.03 | $757.53 | $1,458.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.03 / $18.03 / $18.11
| Professional | | $18.03 | $18.03 | $18.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.01 / $22.37 / $22.37
| Professional | | $19.01 | $22.37 | $22.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.07 / $17.07 / $17.07
| Facility | | $17.07 | $17.07 | $17.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.11 / $18.11 / $25.62
| Professional | | $18.11 | $18.11 | $25.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.11 / $18.11 / $18.11
| Professional | | $18.11 | $18.11 | $18.11 |