- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.59 / $75.14 / $146.51
| Facility | | $57.59 | $75.14 | $146.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.00 / $76.00 / $82.00
| Professional | | $38.00 | $76.00 | $82.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.67 / $43.74 / $54.67
| Professional | | $27.67 | $43.74 | $54.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.62 / $14.62 / $14.62
| Professional | | $14.62 | $14.62 | $14.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.43 / $12.43 / $12.43
| Facility | | $12.43 | $12.43 | $12.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.43 / $12.43 / $12.43
| Professional | | $12.43 | $12.43 | $12.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.62 / $14.62 / $14.62
| Professional | | $14.62 | $14.62 | $14.62 |