- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.05 / $140.05 / $140.05
| Professional | | $25.05 | $140.05 | $140.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.67 / $64.36 / $124.15
| Facility | | $32.67 | $64.36 | $124.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.06 / $24.78 / $30.98
| Professional | | $11.06 | $24.78 | $30.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.67 / $64.36 / $124.15
| Facility | | $32.67 | $64.36 | $124.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.60 / $19.60 / $26.14
| Professional | | $19.60 | $19.60 | $26.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.14 / $9.15 / $21.78
| Professional | | $9.14 | $9.15 | $21.78 |