- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.64 / $41.05 / $57.71
| Professional | | $32.64 | $41.05 | $57.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.00 / $90.00 / $90.00
| Facility | | $90.00 | $90.00 | $90.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.70 / $142.69 / $142.69
| Professional | | $98.70 | $142.69 | $142.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.20 / $30.40 / $36.00
| Facility | | $24.20 | $30.40 | $36.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.24 / $34.38 / $52.72
| Professional | | $28.24 | $34.38 | $52.72 |