- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.01 / $74.40 / $150.93
| Facility | | $23.01 | $74.40 | $150.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $22.28
| Professional | | $20.72 | $20.72 | $22.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.72 / $31.08 / $31.08
| Facility | | $20.72 | $31.08 | $31.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19.54 / $20.72 / $85.00
| Facility | | $19.54 | $20.72 | $85.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $39.22
| Professional | | $20.72 | $20.72 | $39.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23.42 / $71.84 / $114.82
| Facility | | $23.42 | $71.84 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $32.39
| Professional | | $20.72 | $20.72 | $32.39 |