- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.35 / $42.94 / $188.06
| Facility | | $20.35 | $42.94 | $188.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18.20 / $20.35 / $30.45
| Professional | | $18.20 | $20.35 | $30.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.92 / $19.91 / $32.38
| Professional | | $17.92 | $19.91 | $32.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.50 / $30.50 / $30.50
| Professional | | $30.50 | $30.50 | $30.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.00 / $350.00 / $350.00
| Professional | | $350.00 | $350.00 | $350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.89 / $22.74 / $40.94
| Professional | | $17.89 | $22.74 | $40.94 |