- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.15 / $56.00 / $110.26
| Facility | | $35.15 | $56.00 | $110.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.57 / $32.28 / $54.33
| Professional | | $30.57 | $32.28 | $54.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.71 / $33.71 / $33.71
| Facility | | $33.71 | $33.71 | $33.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.71 / $33.71 / $33.71
| Professional | | $33.71 | $33.71 | $33.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.57 / $32.40 / $43.72
| Facility | | $30.57 | $32.40 | $43.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.46 / $51.44 / $70.81
| Facility | | $34.46 | $51.44 | $70.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.97 / $41.00 / $41.00
| Professional | | $35.97 | $41.00 | $41.00 |