- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.85 / $32.85 / $45.79
| Facility | | $32.85 | $32.85 | $45.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.15 / $35.28 / $46.52
| Professional | | $28.15 | $35.28 | $46.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.86 / $32.47 / $44.46
| Professional | | $30.86 | $32.47 | $44.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.06 / $41.43 / $108.52
| Professional | | $29.06 | $41.43 | $108.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.99 / $38.75 / $109.66
| Professional | | $28.99 | $38.75 | $109.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.60 / $79.44 / $115.76
| Professional | | $35.60 | $79.44 | $115.76 |