- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.68 / $77.92 / $119.54
| Facility | | $66.68 | $77.92 | $119.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.56 / $38.20 / $177.87
| Professional | | $30.56 | $38.20 | $177.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.32 / $17.32 / $23.89
| Facility | | $17.32 | $17.32 | $23.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.32 / $17.32 / $23.89
| Facility | | $17.32 | $17.32 | $23.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.32 / $17.32 / $23.89
| Facility | | $17.32 | $17.32 | $23.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $158.10
| Facility | | $60.00 | $60.00 | $158.10 |