- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24.86 / $60.43 / $89.82
| Facility | | $24.86 | $60.43 | $89.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $28.24
| Professional | | $20.72 | $20.72 | $28.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.71 / $20.71 / $22.06
| Professional | | $20.71 | $20.71 | $22.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $26.38
| Professional | | $20.72 | $20.72 | $26.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $29.15
| Professional | | $20.72 | $20.72 | $29.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.72 / $20.72 / $29.89
| Professional | | $20.72 | $20.72 | $29.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.82 / $21.82 / $21.82
| Professional | | $21.82 | $21.82 | $21.82 |