- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.71 / $57.20 / $57.20
| Professional | | $32.71 | $57.20 | $57.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.32 / $62.96 / $94.74
| Professional | | $53.32 | $62.96 | $94.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.86 / $69.29 / $104.76
| Professional | | $53.86 | $69.29 | $104.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.55 / $71.54 / $109.74
| Professional | | $55.55 | $71.54 | $109.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.71 / $57.20 / $57.20
| Professional | | $32.71 | $57.20 | $57.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.77 / $70.56 / $108.91
| Professional | | $49.77 | $70.56 | $108.91 |