- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.05 / $145.63 / $145.63
| Professional | | $26.05 | $145.63 | $145.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.84 / $44.17 / $66.93
| Facility | | $32.84 | $44.17 | $66.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.48 / $32.52 / $32.84
| Professional | | $15.48 | $32.52 | $32.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.84 / $38.51 / $66.93
| Facility | | $32.84 | $38.51 | $66.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.39 / $22.65 / $32.84
| Professional | | $20.39 | $22.65 | $32.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.51 / $9.51 / $22.65
| Professional | | $9.51 | $9.51 | $22.65 |