- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.27 / $47.05 / $78.76
| Professional | | $39.27 | $47.05 | $78.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.22 / $41.77 / $90.27
| Facility | | $33.22 | $41.77 | $90.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.40 / $36.20 / $60.50
| Professional | | $25.40 | $36.20 | $60.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.78 / $1,791.30 / $1,791.30
| Facility | | $57.78 | $1,791.30 | $1,791.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.00 / $163.00 / $163.00
| Professional | | $148.00 | $163.00 | $163.00 |