- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.07 / $14.25 / $35.78
| Professional | | $10.07 | $14.25 | $35.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.73 / $367.14 / $441.88
| Facility | | $100.73 | $367.14 | $441.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.95 / $35.60 / $111.66
| Professional | | $12.95 | $35.60 | $111.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.95 / $35.60 / $111.66
| Professional | | $12.95 | $35.60 | $111.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.35 / $39.94 / $116.11
| Professional | | $34.35 | $39.94 | $116.11 |