- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.05 / $50.57 / $58.16
| Facility | | $21.05 | $50.57 | $58.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.05 / $21.05 / $35.33
| Professional | | $21.05 | $21.05 | $35.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.87 / $23.83 / $23.83
| Facility | | $17.87 | $23.83 | $23.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.64 / $23.59 / $23.82
| Professional | | $22.64 | $23.59 | $23.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.05 / $21.75 / $27.19
| Professional | | $21.05 | $21.75 | $27.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21.05 / $40.00 / $109.76
| Facility | | $21.05 | $40.00 | $109.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.05 / $21.05 / $26.31
| Professional | | $21.05 | $21.05 | $26.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.06 / $25.81 / $38.08
| Facility | | $24.06 | $25.81 | $38.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.06 / $33.90 / $51.74
| Professional | | $24.06 | $33.90 | $51.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.00 / $21.05 / $23.16
| Professional | | $20.00 | $21.05 | $23.16 |