- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.53 / $32.47 / $307.89
| Facility | | $26.53 | $32.47 | $307.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.27 / $26.53 / $34.11
| Professional | | $25.27 | $26.53 | $34.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25.27 / $25.27 / $26.31
| Facility | | $25.27 | $25.27 | $26.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.27 / $25.27 / $25.27
| Professional | | $25.27 | $25.27 | $25.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.26 / $25.27 / $32.85
| Professional | | $24.26 | $25.27 | $32.85 |