- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.15 / $14.02 / $29.11
| Facility | | $12.15 | $14.02 | $29.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.15 / $12.15 / $15.92
| Professional | | $12.15 | $12.15 | $15.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.64 / $67.64 / $67.64
| Professional | | $67.64 | $67.64 | $67.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.39 / $54.94 / $54.94
| Facility | | $37.39 | $54.94 | $54.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.15 / $40.11 / $54.94
| Professional | | $35.15 | $40.11 | $54.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.00 / $200.00 / $493.00
| Professional | | $200.00 | $200.00 | $493.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.99 / $19.48 / $36.56
| Professional | | $12.99 | $19.48 | $36.56 |