- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.19 / $60.50 / $75.63
| Professional | | $52.19 | $60.50 | $75.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $44.37 / $58.15 / $103.41
| Facility | | $44.37 | $58.15 | $103.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.00 / $161.76 / $161.76
| Professional | | $46.00 | $161.76 | $161.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.15 / $52.98 / $57.00
| Facility | | $32.15 | $52.98 | $57.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.01 / $52.98 / $61.53
| Professional | | $34.01 | $52.98 | $61.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.50 / $85.50 / $85.50
| Professional | | $85.50 | $85.50 | $85.50 |