- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.02 / $33.02 / $33.02
| Professional | | $33.02 | $33.02 | $33.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.69 / $321.61 / $337.10
| Facility | | $146.69 | $321.61 | $337.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.65 / $31.65 / $31.65
| Facility | | $31.65 | $31.65 | $31.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.03 / $21.48 / $29.76
| Professional | | $13.03 | $21.48 | $29.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $31.65 / $31.65 / $31.65
| Facility | | $31.65 | $31.65 | $31.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.03 / $21.48 / $29.76
| Professional | | $13.03 | $21.48 | $29.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.26 / $15.86 / $37.00
| Professional | | $8.26 | $15.86 | $37.00 |