- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.50 / $39.31 / $252.76
| Professional | | $32.50 | $39.31 | $252.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.68 / $52.68 / $52.68
| Professional | | $52.68 | $52.68 | $52.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.00 / $66.83 / $224.07
| Facility | | $57.00 | $66.83 | $224.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.00 / $57.00 / $57.00
| Professional | | $57.00 | $57.00 | $57.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $57.00 / $66.83 / $224.07
| Facility | | $57.00 | $66.83 | $224.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.38 / $35.38 / $57.00
| Professional | | $35.38 | $35.38 | $57.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.51 / $16.51 / $39.31
| Professional | | $16.51 | $16.51 | $39.31 |