- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28.43 / $440.59 / $508.13
| Facility | | $28.43 | $440.59 | $508.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.14 / $27.14 / $74.40
| Professional | | $21.14 | $27.14 | $74.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.88 / $35.07 / $46.82
| Professional | | $25.88 | $35.07 | $46.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.45 / $32.34 / $43.66
| Professional | | $24.45 | $32.34 | $43.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.13 / $48.09 / $53.05
| Professional | | $37.13 | $48.09 | $53.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.60 / $28.58 / $38.40
| Professional | | $21.60 | $28.58 | $38.40 |