- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.52 / $54.74 / $64.69
| Facility | | $37.52 | $54.74 | $64.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.00 / $70.00 / $70.00
| Professional | | $70.00 | $70.00 | $70.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.80 / $81.48 / $173.34
| Facility | | $26.80 | $81.48 | $173.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.00 / $300.00 / $300.00
| Professional | | $300.00 | $300.00 | $300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $3.00 / $3.00
| Professional | | $3.00 | $3.00 | $3.00 |