- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.28 / $77.38 / $149.26
| Facility | | $39.28 | $77.38 | $149.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.30 / $22.30 / $27.88
| Professional | | $22.30 | $22.30 | $27.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.28 / $77.38 / $149.26
| Facility | | $39.28 | $77.38 | $149.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.65 / $32.08 / $44.64
| Professional | | $22.65 | $32.08 | $44.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.11 / $10.16 / $24.18
| Professional | | $10.11 | $10.16 | $24.18 |